Healthcare Provider Details

I. General information

NPI: 1023522752
Provider Name (Legal Business Name): DARIUS WILLIAM MORAVIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 AMERICAN WAY STE 1
MEMPHIS TN
38118-8339
US

IV. Provider business mailing address

4095 AMERICAN WAY STE 1
MEMPHIS TN
38118-8339
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-9500
  • Fax: 865-342-0120
Mailing address:
  • Phone: 901-271-9500
  • Fax: 865-342-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: