Healthcare Provider Details

I. General information

NPI: 1679042782
Provider Name (Legal Business Name): DAVID MAX EVERITT MCD CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 POPLAR PIKE
MEMPHIS TN
38119-4707
US

IV. Provider business mailing address

6133 POPLAR PIKE
MEMPHIS TN
38119-4707
US

V. Phone/Fax

Practice location:
  • Phone: 901-415-6667
  • Fax: 901-415-6648
Mailing address:
  • Phone: 901-415-6667
  • Fax: 901-415-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00001387
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: