Basic Information
| Provider Information | |||||||||
| NPI: | 1083737142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORCORAN | ||||||||
| FirstName: | JULIE ANN | ||||||||
| MiddleName: | ELISABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 WEST BROADWAY AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652731752 | ||||||||
| FaxNumber: | 8652731755 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 BMH PHYSICIANS OFFICE BLDG | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656814800 | ||||||||
| FaxNumber: | 8656815558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OS016069 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 265598-1 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208D00000X | OT011837 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 208600000X | 2465 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q013157 | 05 | TN | MEDICAID |