Healthcare Provider Details

I. General information

NPI: 1770649667
Provider Name (Legal Business Name): HEALTH CARE CLINIC OF TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 KNIGHT ARNOLD RD SUITE 201
MEMPHIS TN
38118-3035
US

IV. Provider business mailing address

405 N HAYDEN ST
BELZONI MS
39038-3639
US

V. Phone/Fax

Practice location:
  • Phone: 901-345-5853
  • Fax: 901-346-9588
Mailing address:
  • Phone: 662-247-1254
  • Fax: 662-247-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLARA T. REED
Title or Position: CEO
Credential: RN
Phone: 662-247-1254