Healthcare Provider Details

I. General information

NPI: 1659788974
Provider Name (Legal Business Name): UTMG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 JEFFERSON
MEMPHIS TN
38104
US

IV. Provider business mailing address

1407 UNION AVE
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7366
  • Fax:
Mailing address:
  • Phone: 901-866-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number38473
License Number StateTN

VIII. Authorized Official

Name: MS. MARILYN MUIRHEAD
Title or Position: NNP
Credential: RN
Phone: 901-866-8808