Healthcare Provider Details

I. General information

NPI: 1447012455
Provider Name (Legal Business Name): CALEIGH DEMARZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 MONTGOMERY AVE APT 5
MOUNT CARMEL TN
37645-3593
US

IV. Provider business mailing address

358 MONTGOMERY AVE APT 5
MOUNT CARMEL TN
37645-3593
US

V. Phone/Fax

Practice location:
  • Phone: 423-963-0346
  • Fax:
Mailing address:
  • Phone: 423-963-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000004319
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: