Healthcare Provider Details

I. General information

NPI: 1205119229
Provider Name (Legal Business Name): TENNESSEE TRAINING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 OLD GETWELL RD
MEMPHIS TN
38118-3634
US

IV. Provider business mailing address

6926 SPRING RIVER RD
MEMPHIS TN
38141-0513
US

V. Phone/Fax

Practice location:
  • Phone: 901-301-7411
  • Fax:
Mailing address:
  • Phone: 901-301-7411
  • Fax: 901-363-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI SWANIGAN
Title or Position: CEO
Credential:
Phone: 901-301-7411