MEDICARE: LYQUALA BUFORD

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
1	385H00000X	Respite Care

General Provider Information

NPI Number	:	1194343830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYQUALA BUFORD

Provider Business Mailing Address
First Line	:	PO BOX 16822
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38186-0822
Country	:	US
Telephone Number	:	901-590-6662
Fax Number	:	901-684-0098

Provider Business Practice Location Address
First Line	:	6095 APPLE TREE DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-8600
Country	:	US
Telephone Number	:	901-590-6662
Fax Number	:	901-684-0098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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Directions to “ LYQUALA BUFORD ” Practice Location

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