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General NPI Number Information
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NPI Number | 1679042782
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Entity Type | Individual
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Provider Name | DAVID MAX EVERITT MCD CCC-A
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Gender | Male
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 6133 POPLAR PIKE
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City | MEMPHIS
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State | TN
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Zip | 38119-4707
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Country | US
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Telephone | 901-415-6667
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Fax | 901-415-6648
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Provider Business Mailing Address
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Address Line | 6133 POPLAR PIKE
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City | MEMPHIS
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State | TN
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Zip | 38119-4707
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Country | US
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Telephone | 901-415-6667
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Fax | 901-415-6648
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 00001387
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License Number State | TN
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