Provider Demographics
NPI:1508012196
Name:MASSEY, MICHELLE MARIE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GERMANTOWN BEND CV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4267
Mailing Address - Country:US
Mailing Address - Phone:901-759-9337
Mailing Address - Fax:901-759-7967
Practice Address - Street 1:310 GERMANTOWN BEND CV
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4267
Practice Address - Country:US
Practice Address - Phone:901-759-9337
Practice Address - Fax:901-759-7967
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370194Medicare PIN