Provider Demographics
NPI:1679042782
Name:EVERITT, DAVID MAX (MCD CCC-A)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MAX
Last Name:EVERITT
Suffix:
Gender:M
Credentials:MCD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4707
Mailing Address - Country:US
Mailing Address - Phone:901-415-6667
Mailing Address - Fax:901-415-6648
Practice Address - Street 1:6133 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4707
Practice Address - Country:US
Practice Address - Phone:901-415-6667
Practice Address - Fax:901-415-6648
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00001387231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist