Healthcare Provider Details

I. General information

NPI: 1184840373
Provider Name (Legal Business Name): U. OF TENNESSEE GME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE STE C50 UT COLLEGE OF MEDICINE
MEMPHIS TN
38103-3493
US

IV. Provider business mailing address

1267 ISLAND HARBOR DRIVE
MEMPHIS TN
38103
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5364
  • Fax:
Mailing address:
  • Phone: 901-289-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. FANG YU
Title or Position: RADIOLGY RESIDENT
Credential:
Phone: 901-289-1475