Healthcare Provider Details

I. General information

NPI: 1073203410
Provider Name (Legal Business Name): BRANDON DAVIS CONAWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

369 WINDING RIVER CIR APT 206
MEMPHIS TN
38120-2900
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7100
  • Fax:
Mailing address:
  • Phone: 731-695-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number45291
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: