Healthcare Provider Details

I. General information

NPI: 1861112930
Provider Name (Legal Business Name): NITA S DESAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GETWELL RD
MEMPHIS TN
38118-2205
US

IV. Provider business mailing address

PO BOX 17171
MEMPHIS TN
38187-0171
US

V. Phone/Fax

Practice location:
  • Phone: 901-877-7897
  • Fax: 901-877-7991
Mailing address:
  • Phone: 901-877-7897
  • Fax: 901-877-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY M MOORE
Title or Position: AR MANAGER
Credential:
Phone: 901-877-7897