Healthcare Provider Details

I. General information

NPI: 1902651193
Provider Name (Legal Business Name): ADRIANNE MEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 BLACKWELL RD
BARTLETT TN
38134-3414
US

IV. Provider business mailing address

5640 BLACKWELL RD
BARTLETT TN
38134-3414
US

V. Phone/Fax

Practice location:
  • Phone: 901-268-0601
  • Fax:
Mailing address:
  • Phone: 901-268-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number210749
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: