Provider Demographics
NPI:1073578738
Name:MCMAHON, YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3582
Mailing Address - Country:US
Mailing Address - Phone:931-528-0095
Mailing Address - Fax:
Practice Address - Street 1:345 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2331
Practice Address - Country:US
Practice Address - Phone:931-528-1485
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000017671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4100509OtherBLUE CROSS-BLUE SHIELD
TN3054756Medicaid
TN3054756Medicaid