Provider Demographics
NPI:1235230707
Name:MCCARLEY, KENNETH HUGH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:HUGH
Last Name:MCCARLEY
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 1:2414 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3879
Mailing Address - Country:US
Mailing Address - Phone:423-472-6581
Mailing Address - Fax:423-472-2425
Practice Address - Street 1:2414 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3879
Practice Address - Country:US
Practice Address - Phone:423-472-6581
Practice Address - Fax:423-472-2425
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28710207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1811876Medicaid
E73070Medicare UPIN
TN1811876Medicaid