Provider Demographics
NPI:1174694434
Name:COX, MARY DAWN (EDD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DAWN
Last Name:COX
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 TROTWOOD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1803
Mailing Address - Country:US
Mailing Address - Phone:615-406-0593
Mailing Address - Fax:605-468-0926
Practice Address - Street 1:1121 TROTWOOD AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1803
Practice Address - Country:US
Practice Address - Phone:615-406-0593
Practice Address - Fax:615-468-0926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2071103T00000X
TNP0000002071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
454915266OtherEIN
454915266OtherEIN