Provider Demographics
NPI:1821356981
Name:EVERINGHAM, NEIL MARK (AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:MARK
Last Name:EVERINGHAM
Suffix:
Gender:M
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8090 WALNUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6362
Mailing Address - Country:US
Mailing Address - Phone:901-755-5300
Mailing Address - Fax:901-753-9659
Practice Address - Street 1:8090 WALNUT RUN RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6362
Practice Address - Country:US
Practice Address - Phone:901-755-5300
Practice Address - Fax:901-753-9659
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001260231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I642356Medicare PIN