Healthcare Provider Details

I. General information

NPI: 1306162326
Provider Name (Legal Business Name): NEELAM JAIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL PLACE DR STE 400
MEMPHIS TN
38120-1431
US

IV. Provider business mailing address

1661 INTERNATIONAL PLACE DR STE 400
MEMPHIS TN
38120-1431
US

V. Phone/Fax

Practice location:
  • Phone: 901-410-9524
  • Fax: 901-432-2415
Mailing address:
  • Phone: 901-410-9524
  • Fax: 901-432-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP0000002840
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: