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NPI Code Detail

MEDICARE: UNIVERSITY OF TENNESSEE

MEDICARE: UNIVERSITY OF TENNESSEE
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
1207Q00000XFamily Medicine PhysicianTN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780686170
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF TENNESSEE
Provider Business Mailing Address
First Line : 16 BRENTSHIRE SQ
Second Line :
City : JACKSON
State : TN
Zip : 38305-2203
Country : US
Telephone Number : 731-664-0994
Fax Number : 731-664-0866
Provider Business Practice Location Address
First Line : 1301 PRIMACY PKWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-0213
Country : US
Telephone Number : 901-448-0275
Fax Number : 901-448-0404
Authorized Official
Title or Position : DIRECTOR
Name : MYRA L SULLIVAN
Credential :
Telephone Number : 901-448-2847
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/21/2022

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1356392567 — DR. PEGGY ANN O'CAIN MD
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1609802420 — DR. CHRISTA MICHELLE GEORGE PHARM.D.
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1124119755 — DR. WILLIAM DONALD DUNN PHARM.D.
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Directions to “UNIVERSITY OF TENNESSEE ” Practice Location

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