Healthcare Provider Details

I. General information

NPI: 1588311567
Provider Name (Legal Business Name): EBONIE MARCUISA GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MAPLEHURST DR
MEMPHIS TN
38127-8224
US

IV. Provider business mailing address

2360 MAPLEHURST DR
MEMPHIS TN
38127-8224
US

V. Phone/Fax

Practice location:
  • Phone: 901-578-5599
  • Fax:
Mailing address:
  • Phone: 901-578-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: