MEDICARE: MACEY DIEDRICH PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1558210120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACEY DIEDRICH PA-C

Provider Business Mailing Address
First Line	:	1260 MARTIN ST APT 310
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-4897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 MARTIN ST APT 310
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-4897
Country	:	US
Telephone Number	:	214-681-2944
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ MACEY DIEDRICH PA-C” Practice Location

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