Provider Demographics
NPI:1275962763
Name:MAKARIOS GROUP 5, INC
Entity Type:Organization
Organization Name:MAKARIOS GROUP 5, INC
Other - Org Name:NEW LIFE TESTOSTERONE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:901-213-0100
Mailing Address - Street 1:8950 US HIGHWAY 64
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4566
Mailing Address - Country:US
Mailing Address - Phone:901-213-0100
Mailing Address - Fax:901-213-0101
Practice Address - Street 1:8950 US HIGHWAY 64
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-4566
Practice Address - Country:US
Practice Address - Phone:901-213-0100
Practice Address - Fax:901-213-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care