Healthcare Provider Details

I. General information

NPI: 1639492002
Provider Name (Legal Business Name): DR. ADDIELENE FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CENTURY CENTER PKWY
MEMPHIS TN
38134-8822
US

IV. Provider business mailing address

4269 EVENING WIND CV
MEMPHIS TN
38141-7023
US

V. Phone/Fax

Practice location:
  • Phone: 901-381-7400
  • Fax:
Mailing address:
  • Phone: 901-365-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5794
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: