Basic Information
| Provider Information | |||||||||
| NPI: | 1003101957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4439 STATE ROUTE 159 STE 150 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407798840 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4439 STATE ROUTE 159 STE 150 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407798840 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34.010928 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.