Healthcare Provider Details

I. General information

NPI: 1104220649
Provider Name (Legal Business Name): VINTEARIA CAUTHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 HALLBROOK ST
MEMPHIS TN
38127-5626
US

IV. Provider business mailing address

6949 AMBERLY VILLAGE DR
CORDOVA TN
38018-5619
US

V. Phone/Fax

Practice location:
  • Phone: 901-258-9702
  • Fax:
Mailing address:
  • Phone: 901-258-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: