Healthcare Provider Details

I. General information

NPI: 1912449711
Provider Name (Legal Business Name): AYESHA GHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR
MEMPHIS TN
38125-8906
US

IV. Provider business mailing address

9267 BREAKSTONE CV
COLLIERVILLE TN
38017-9740
US

V. Phone/Fax

Practice location:
  • Phone: 901-969-4561
  • Fax:
Mailing address:
  • Phone: 901-647-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3146
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: