Healthcare Provider Details

I. General information

NPI: 1669010104
Provider Name (Legal Business Name): ELISABETH KATHLEEN GUTHRIE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE STE 302
MEMPHIS TN
38119-4823
US

IV. Provider business mailing address

2670 UNION AVENUE EXT STE 801
MEMPHIS TN
38112-4416
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-0044
  • Fax:
Mailing address:
  • Phone: 901-726-0044
  • Fax: 901-726-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1963
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: