1831385376 NPI number — MS. MARCHEL D TINNEY APN

Table of content: MS. MARCHEL D TINNEY APN (NPI 1831385376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831385376 NPI number — MS. MARCHEL D TINNEY APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINNEY
Provider First Name:
MARCHEL
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAINES
Provider Other First Name:
MARCHEL
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831385376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4841 HIXSON PIKE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-4431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-305-7980
Provider Business Mailing Address Fax Number:
423-305-7981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4841 HIXSON PIKE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-305-7980
Provider Business Practice Location Address Fax Number:
423-305-7981
Provider Enumeration Date:
09/19/2007

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: 363LF0000X , with the licence number:  12872 , 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: 11789785 . This is a "CAQH #" identifier . This identifiers is of the category "OTHER".




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