Provider Demographics
NPI:1124032479
Name:MCDUFFIE, EVERETT ELLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:ELLISON
Last Name:MCDUFFIE
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 1:200 DECK LN
Mailing Address - Street 2:UNIT 1001
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-6339
Mailing Address - Country:US
Mailing Address - Phone:423-573-1409
Mailing Address - Fax:
Practice Address - Street 1:200 DECK LN
Practice Address - Street 2:UNIT 1001
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-6339
Practice Address - Country:US
Practice Address - Phone:423-573-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN409582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry