Healthcare Provider Details

I. General information

NPI: 1902278179
Provider Name (Legal Business Name): UNIVERSITY OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE. ROOMS S510B
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

875 UNION AVE ROOMS C211B
MEMPHIS TN
38163-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-7196
  • Fax: 901-448-7104
Mailing address:
  • Phone: 901-448-2801
  • Fax: 901-448-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY A FERRARA
Title or Position: VICE CHANCELLOR/CHIEF FINANCIAL OFF
Credential:
Phone: 901-448-5523