Healthcare Provider Details

I. General information

NPI: 1134731821
Provider Name (Legal Business Name): AUTISM CENTERS OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 QUINCE RD STE 120
MEMPHIS TN
38119-8037
US

IV. Provider business mailing address

1466 WOOD TRAIL CIR
CORDOVA TN
38016-6124
US

V. Phone/Fax

Practice location:
  • Phone: 901-567-5361
  • Fax: 901-321-5257
Mailing address:
  • Phone: 901-463-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ALICIA ADAIR
Title or Position: AUTISM PROGRAM DIRECTOR
Credential: BCBA
Phone: 901-567-5361