Healthcare Provider Details

I. General information

NPI: 1720385206
Provider Name (Legal Business Name): MRS. CHERYL S FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 POPLAR AVE SUITE 312
MEMPHIS TN
38117-4430
US

IV. Provider business mailing address

9330 JAYNE LEWIS CV
MEMPHIS TN
38133-0962
US

V. Phone/Fax

Practice location:
  • Phone: 901-864-4637
  • Fax: 901-379-3530
Mailing address:
  • Phone: 901-828-2670
  • Fax: 901-379-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number55698333
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: