Provider Demographics
NPI:1447323639
Name:MCMAHAN, CONNIE (ADVANCED PRACTICE NU)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HIGHWAY
Mailing Address - Street 2:B100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-544-6570
Mailing Address - Fax:865-544-6576
Practice Address - Street 1:1928 ALCOA HIGHWAY
Practice Address - Street 2:B100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-544-6570
Practice Address - Fax:865-544-6576
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN67898207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN67898OtherLICENSE
3344385Medicare ID - Type Unspecified