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General NPI Number Information
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NPI Number | 1336605864
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Entity Type | Organization
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Legal Business Name | MAXMED CARE SERVICES
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1950 N JACKSON ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-2204
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Country | US
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Telephone | 931-393-2362
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Fax | 931-393-3212
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Provider Business Mailing Address
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Address Line | 5103 MOUNTAIN BREEZE CT
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City | LA VERGNE
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State | TN
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Zip | 37086-4914
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Country | US
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Telephone | 931-393-2362
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Fax | 931-393-3212
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Authorized Official
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Title or Position | MEMBER
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Name | HEATHER C BOHANNON-IYAMA
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Credential | NP
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Telephone | 931-393-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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