Healthcare Provider Details

I. General information

NPI: 1346797321
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF MEMPHIS & THE MID-SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MADISON AVE
MEMPHIS TN
38103-2731
US

IV. Provider business mailing address

6373 N QUAIL HOLLOW RD SUITE 201
MEMPHIS TN
38120-1405
US

V. Phone/Fax

Practice location:
  • Phone: 901-527-9622
  • Fax: 901-527-9638
Mailing address:
  • Phone: 901-766-7677
  • Fax: 901-766-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH JOHNSON
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 901-766-7677