Healthcare Provider Details

I. General information

NPI: 1760393920
Provider Name (Legal Business Name): LENOU MARK PHIAPALATH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 S MENDENHALL RD STE 6
MEMPHIS TN
38115-5914
US

IV. Provider business mailing address

1849 BLACK BEAR CIR W
CORDOVA TN
38016-1506
US

V. Phone/Fax

Practice location:
  • Phone: 901-365-1800
  • Fax:
Mailing address:
  • Phone: 901-692-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number210916
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: