MEDICARE: AALIYAH MONNAY GORE

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1518539543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AALIYAH MONNAY GORE

Provider Business Mailing Address
First Line	:	105D BALL HALL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38152-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105D BALL HALL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38152-3502
Country	:	US
Telephone Number	:	901-677-8618
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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