Healthcare Provider Details

I. General information

NPI: 1699410514
Provider Name (Legal Business Name): EMILIE LAURA UNGRICHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MADISON AVE STE 470
MEMPHIS TN
38103-7400
US

IV. Provider business mailing address

UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447
MEMPHIS TN
38163-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1767
  • Fax:
Mailing address:
  • Phone: 901-448-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14278720-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: