Provider Demographics
NPI:1871998286
Name:CALAIN, MANDA L
Entity type:Individual
Prefix:MRS
First Name:MANDA
Middle Name:L
Last Name:CALAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-4107
Mailing Address - Country:US
Mailing Address - Phone:423-388-8739
Mailing Address - Fax:423-330-6507
Practice Address - Street 1:702 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:UNICOI
Practice Address - State:TN
Practice Address - Zip Code:37692-4107
Practice Address - Country:US
Practice Address - Phone:423-388-8739
Practice Address - Fax:423-330-6507
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies