Healthcare Provider Details

I. General information

NPI: 1447025218
Provider Name (Legal Business Name): JOPPA MARTIN MA, EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 CHARING CROSS ST
MEMPHIS TN
38116-2009
US

IV. Provider business mailing address

4551 CHARING CROSS ST
MEMPHIS TN
38116-2009
US

V. Phone/Fax

Practice location:
  • Phone: 901-208-1742
  • Fax:
Mailing address:
  • Phone: 901-208-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number2929506
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: