Healthcare Provider Details

I. General information

NPI: 1780767475
Provider Name (Legal Business Name): DEBRA MCLEMORE DUFFY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 BERT JOHNSTON AVE
COVINGTON TN
38019-2414
US

IV. Provider business mailing address

3012 ELGIN DR
MEMPHIS TN
38115-2213
US

V. Phone/Fax

Practice location:
  • Phone: 901-475-0027
  • Fax:
Mailing address:
  • Phone: 901-565-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4690819
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: