Provider Demographics
NPI:1750891677
Name:DIABETES MANAGEMENT ASSOCIATES
Entity type:Organization
Organization Name:DIABETES MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:931-325-5560
Mailing Address - Street 1:401 FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474
Mailing Address - Country:US
Mailing Address - Phone:931-325-5560
Mailing Address - Fax:
Practice Address - Street 1:401 FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474
Practice Address - Country:US
Practice Address - Phone:931-325-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74273163WD0400X
TN6172363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty