Provider Demographics
NPI:1093163925
Name:PRESCOTT, NOELLE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANNE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:ANNE
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2946
Mailing Address - Country:US
Mailing Address - Phone:205-926-2992
Mailing Address - Fax:
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-383-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59325207Q00000X
PAMT210995390200000X
ALMD.43368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program