Healthcare Provider Details

I. General information

NPI: 1407149776
Provider Name (Legal Business Name): MARCHICA TERRELL PARRAM CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5157 PATRICK HENRY DR
MEMPHIS TN
38134-2906
US

IV. Provider business mailing address

PO BOX 34162
MEMPHIS TN
38184-0162
US

V. Phone/Fax

Practice location:
  • Phone: 901-239-1124
  • Fax:
Mailing address:
  • Phone: 901-239-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number3681
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: