Provider Demographics
NPI:1427006626
Name:FLOYD, MICHAEL R (EDD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:FLOYD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1230
Mailing Address - Country:US
Mailing Address - Phone:423-306-3249
Mailing Address - Fax:423-464-4212
Practice Address - Street 1:208 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1230
Practice Address - Country:US
Practice Address - Phone:423-306-3249
Practice Address - Fax:423-464-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP930103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
07/01/1948OtherD.O.B
07/01/1948OtherD.O.B