Individual
MR. JOHNNY MICHAEL MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1001 MCARTHUR STREET, UNITED REGIONAL MEDICAL CENTER, MANCHESTER, TN 37355
(931) 728-3586
(931) 728-6877
Mailing address
308 AMHERST DRIVE, TULLAHOMA, TN 37388
(931) 393-3515
(931) 728-6877
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D34444
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3250236
—
TN
01
—
4085915
BLUE CROSS BLUE SHIELD
TN
Enumeration date
08/18/2006
Last updated
07/08/2007
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