Healthcare Provider Details

I. General information

NPI: 1699076414
Provider Name (Legal Business Name): LIFELINC INTERVENTIONAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 UNION AVE STE 927
MEMPHIS TN
38104-7555
US

IV. Provider business mailing address

1331 UNION AVE STE 927
MEMPHIS TN
38104-7555
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-1590
  • Fax: 901-844-1592
Mailing address:
  • Phone: 901-844-1590
  • Fax: 901-844-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NATARSHA GRANT
Title or Position: PRESIDENT
Credential: MD
Phone: 901-844-1590