Provider Demographics
NPI:1013195452
Name:MCNULTY, NORMAN LIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:LIN
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0248
Mailing Address - Country:US
Mailing Address - Phone:931-766-3637
Mailing Address - Fax:
Practice Address - Street 1:1605 S LOCUST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4061
Practice Address - Country:US
Practice Address - Phone:931-766-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA945012084N0400X
TN480762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527695Medicaid
AL89037343OtherBCBS AL
TN4327130OtherBCBS TN
AL89037343OtherBCBS AL