MEDICARE: DR. NEELAM JAIN 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
1	103G00000X	Clinical Neuropsychologist	P0000002840	TN

General Provider Information

NPI Number	:	1306162326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELAM JAIN PH.D.

Provider Business Mailing Address
First Line	:	1661 INTERNATIONAL PLACE DR STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-1431
Country	:	US
Telephone Number	:	901-410-9524
Fax Number	:	901-432-2415

Provider Business Practice Location Address
First Line	:	1661 INTERNATIONAL PLACE DR STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-1431
Country	:	US
Telephone Number	:	901-410-9524
Fax Number	:	901-432-2415

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/22/2019

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