Healthcare Provider Details

I. General information

NPI: 1457163792
Provider Name (Legal Business Name): ALEXANDER DAVID HURLEY CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 N DUNLAP ST # 138
MEMPHIS TN
38103-2802
US

IV. Provider business mailing address

49 N DUNLAP ST # 138
MEMPHIS TN
38103-2802
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7817
  • Fax:
Mailing address:
  • Phone: 901-287-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: