1235597444 NPI number — AUTUMN MAY

Table of content: AUTUMN MAY (NPI 1235597444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235597444 NPI number — AUTUMN MAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAY
Provider First Name:
AUTUMN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235597444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 HIRAM GREEN LN
Provider Second Line Business Mailing Address:
DAYTON
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37321-7650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-356-7657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4589 RHEA COUNTY HWY
Provider Second Line Business Practice Location Address:
DAYTON
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37321-6076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-507-1212
Provider Business Practice Location Address Fax Number:
931-507-1217
Provider Enumeration Date:
02/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  87723 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87723 . This is a "LPN LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com