Healthcare Provider Details

I. General information

NPI: 1154467082
Provider Name (Legal Business Name): MRS. CAROL JUBERT BRADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 LINDEN AVE
MEMPHIS TN
38126-2023
US

IV. Provider business mailing address

1799 W HOLMES RD
MEMPHIS TN
38109-6065
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-9311
  • Fax: 901-577-0207
Mailing address:
  • Phone: 901-577-9311
  • Fax: 901-577-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: