Healthcare Provider Details

I. General information

NPI: 1669728143
Provider Name (Legal Business Name): SUZANNE P TAGG DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE PARKER

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 STAGE RD STE B
BARTLETT TN
38134
US

IV. Provider business mailing address

5724 STAGE RD STE B
BARTLETT TN
38134-4572
US

V. Phone/Fax

Practice location:
  • Phone: 844-646-2279
  • Fax: 901-646-7706
Mailing address:
  • Phone: 844-646-2279
  • Fax: 901-646-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7667
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7667
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number7667
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: