Healthcare Provider Details

I. General information

NPI: 1750696340
Provider Name (Legal Business Name): BLUES CITY PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8336 MACON RD
CORDOVA TN
38018-8554
US

IV. Provider business mailing address

1138 N GERMANTOWN PKWY SUITE 101-110
CORDOVA TN
38016-5872
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-3035
  • Fax: 901-628-3049
Mailing address:
  • Phone: 901-737-1992
  • Fax: 901-309-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42712
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SHUBI R MUKATIRA
Title or Position: OWNER
Credential: MD
Phone: 901-737-1992