Provider Demographics
NPI:1578514998
Name:AUSTIN, MARY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-1149
Mailing Address - Country:US
Mailing Address - Phone:731-512-0494
Mailing Address - Fax:731-512-0497
Practice Address - Street 1:HENRY COUNTY MEDICAL CENTER EMERGENCY DEPT.
Practice Address - Street 2:301 TYSON AVE.
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-1030
Practice Address - Country:US
Practice Address - Phone:731-644-8445
Practice Address - Fax:731-644-8446
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO1154207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3304913Medicaid
TN3304913Medicaid
TNG51398Medicare UPIN