Provider Demographics
NPI:1184952137
Name:MCDOUGAL, GAYLEA (CPM-TN)
Entity type:Individual
Prefix:
First Name:GAYLEA
Middle Name:
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:CPM-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MCDOUGAL LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4998
Mailing Address - Country:US
Mailing Address - Phone:615-243-4830
Mailing Address - Fax:615-527-7423
Practice Address - Street 1:199 MCDOUGAL LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-4998
Practice Address - Country:US
Practice Address - Phone:615-243-4830
Practice Address - Fax:615-527-7423
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife