MEDICARE: TRINITY HOLISTIC PRIMARY CARE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1598348211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOLISTIC PRIMARY CARE

Provider Business Mailing Address
First Line	:	335 LILLIAN DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-4431
Country	:	US
Telephone Number	:	901-653-4136
Fax Number	:	901-509-3991

Provider Business Practice Location Address
First Line	:	335 LILLIAN DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-4431
Country	:	US
Telephone Number	:	901-653-4136
Fax Number	:	901-509-3991

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SANDRA DEE GARRISON
Credential	:	NP
Telephone Number	:	901-653-4136

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/30/2021

Similar Medicare Providers

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