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General NPI Number Information
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NPI Number | 1073578738
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Entity Type | Individual
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Provider Name | YVONNE MCMAHON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 345 W BROAD ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-2331
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Country | US
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Telephone | 931-528-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 425 S MAPLE AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-3582
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Country | US
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Telephone | 931-528-0095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD0000017671
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License Number State | TN
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