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NPI Code Detail

MEDICARE: DR. WANDA HALL-MYERS PH.D.

MEDICARE: DR. WANDA HALL-MYERS PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistP0000002394TN

General Provider Information

NPI Number : 1083643431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WANDA HALL-MYERS PH.D.
Provider Business Mailing Address
First Line : 2595 CENTRAL AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-5905
Country : US
Telephone Number : 901-842-3160
Fax Number : 901-842-2360
Provider Business Practice Location Address
First Line : 711 JEFFERSON AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38105-5003
Country : US
Telephone Number : 901-448-6511
Fax Number : 901-448-7097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 03/05/2019

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