MEDICARE: MR. NEIL MARK EVERINGHAM AUDIOLOGIST

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	231H00000X	Audiologist	A0000001260	TN

General Provider Information

NPI Number	:	1821356981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL MARK EVERINGHAM AUDIOLOGIST

Provider Business Mailing Address
First Line	:	8090 WALNUT RUN RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-6362
Country	:	US
Telephone Number	:	901-755-5300
Fax Number	:	901-753-9659

Provider Business Practice Location Address
First Line	:	8090 WALNUT RUN RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-6362
Country	:	US
Telephone Number	:	901-755-5300
Fax Number	:	901-753-9659

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	12/11/2012

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