Healthcare Provider Details

I. General information

NPI: 1649791393
Provider Name (Legal Business Name): VACHENZIA MCGRAW-MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 HACKS CROSS RD STE 102-218
MEMPHIS TN
38125-2367
US

IV. Provider business mailing address

3750 HACKS CROSS RD STE 102-218
MEMPHIS TN
38125-2367
US

V. Phone/Fax

Practice location:
  • Phone: 901-443-0913
  • Fax:
Mailing address:
  • Phone: 901-443-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: