Healthcare Provider Details

I. General information

NPI: 1225794209
Provider Name (Legal Business Name): DEMETRIA GIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 LAPALOMA ST
MEMPHIS TN
38114-4574
US

IV. Provider business mailing address

1809 LAPALOMA ST
MEMPHIS TN
38114-4574
US

V. Phone/Fax

Practice location:
  • Phone: 901-364-2574
  • Fax: 901-590-3782
Mailing address:
  • Phone: 901-364-2574
  • Fax: 901-590-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: