Healthcare Provider Details

I. General information

NPI: 1871998286
Provider Name (Legal Business Name): MRS. MANDA L CALAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MASSACHUSETTS AVE
UNICOI TN
37692-4107
US

IV. Provider business mailing address

702 MASSACHUSETTS AVE
UNICOI TN
37692-4107
US

V. Phone/Fax

Practice location:
  • Phone: 423-388-8739
  • Fax: 423-330-6507
Mailing address:
  • Phone: 423-388-8739
  • Fax: 423-330-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: