Healthcare Provider Details

I. General information

NPI: 1295296762
Provider Name (Legal Business Name): WOMEN'S CARE CENTER OF MEMPHIS 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 HUMPHREYS BLVD STE 500
MEMPHIS TN
38120-2384
US

IV. Provider business mailing address

PO BOX 468329
ATLANTA GA
31146-8329
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-0630
  • Fax: 901-682-0635
Mailing address:
  • Phone: 404-943-0205
  • Fax: 404-943-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY DEPP
Title or Position: PAYER RELATIONS LIAISON
Credential:
Phone: 770-579-2626