Healthcare Provider Details

I. General information

NPI: 1659134906
Provider Name (Legal Business Name): MEMPHIS PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 ROGERS RD
CORDOVA TN
38018-8546
US

IV. Provider business mailing address

1088 ROGERS RD
CORDOVA TN
38018-8546
US

V. Phone/Fax

Practice location:
  • Phone: 901-277-9494
  • Fax:
Mailing address:
  • Phone: 901-277-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. UTHAPPA THAMMAIAH MUKATIRA
Title or Position: OWNER
Credential: PHD
Phone: 901-277-9494