Healthcare Provider Details

I. General information

NPI: 1568773521
Provider Name (Legal Business Name): BRANDON C BAUGHMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

IV. Provider business mailing address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-7700
  • Fax: 901-522-2600
Mailing address:
  • Phone: 901-522-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2970
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: