Healthcare Provider Details

I. General information

NPI: 1902080815
Provider Name (Legal Business Name): JENNIFER LAUREL SNOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 HUMPHREYS BLVD
MEMPHIS TN
38120-2373
US

IV. Provider business mailing address

6225 HUMPHREYS BLVD STE 5300
MEMPHIS TN
38120-2373
US

V. Phone/Fax

Practice location:
  • Phone: 804-298-4255
  • Fax:
Mailing address:
  • Phone: 804-298-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number54240
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: