Healthcare Provider Details

I. General information

NPI: 1124455373
Provider Name (Legal Business Name): MARGARET LASHUN HENDERSON-LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 JUDICIAL DR
GERMANTOWN TN
38138-3823
US

IV. Provider business mailing address

3249 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

V. Phone/Fax

Practice location:
  • Phone: 901-421-5174
  • Fax:
Mailing address:
  • Phone: 901-756-5565
  • Fax: 901-756-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET HENDERSON-LEE
Title or Position: CEO
Credential:
Phone: 901-421-5174