Provider Demographics
NPI:1073764692
Name:MACEVOY, ADAM C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:C
Last Name:MACEVOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-3986
Mailing Address - Country:US
Mailing Address - Phone:901-381-2800
Mailing Address - Fax:
Practice Address - Street 1:7424 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-3986
Practice Address - Country:US
Practice Address - Phone:901-381-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003539213ES0103X, 213ES0131X, 213EP1101X, 213ES0000X, 213E00000X
TNDPM0000000705213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDPM0000000705OtherSTATE LICENSE
OH36.003539OtherSTATE LICENSE
TN1526688Medicaid
OH36.003539OtherSTATE LICENSE