Healthcare Provider Details

I. General information

NPI: 1942273115
Provider Name (Legal Business Name): OCCUMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 SOUTHWIDE DR
MEMPHIS TN
38118-1537
US

IV. Provider business mailing address

6517 N COUNTRY OAKS CIR
MEMPHIS TN
38115-5282
US

V. Phone/Fax

Practice location:
  • Phone: 901-797-6805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number805
License Number StateTN

VIII. Authorized Official

Name: APRIL PARHAM
Title or Position: ATHLETIC TRAINER
Credential:
Phone: 901-601-7244