MEDICARE: DR. JOHN W MCCOY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	P503	TN

General Provider Information

NPI Number	:	1548230691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN W MCCOY PHD

Provider Business Mailing Address
First Line	:	520 EASTBOURNE PL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-3643
Country	:	US
Telephone Number	:	901-756-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-7503
Country	:	US
Telephone Number	:	901-756-5583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/26/2008

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