Healthcare Provider Details

I. General information

NPI: 1043947724
Provider Name (Legal Business Name): JAMES DRUCKENMILLER HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM DRUCKENMILLER

II. Dates (important events)

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

III. Provider practice location address

4515 POPLAR AVE STE 108-B
MEMPHIS TN
38117-7503
US

IV. Provider business mailing address

7600 DEXTER PARK DR
CORDOVA TN
38016-8749
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-3045
  • Fax:
Mailing address:
  • Phone: 901-301-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: