Healthcare Provider Details

I. General information

NPI: 1164910758
Provider Name (Legal Business Name): URBAN ALPHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6286 QUINCE RD
MEMPHIS TN
38119-7629
US

IV. Provider business mailing address

6286 QUINCE RD
MEMPHIS TN
38119-7629
US

V. Phone/Fax

Practice location:
  • Phone: 901-265-8517
  • Fax: 901-339-6304
Mailing address:
  • Phone: 901-265-8517
  • Fax: 901-339-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH DONNELL WILLIAMS
Title or Position: OWNER
Credential: PHLEBOTOMIST
Phone: 901-265-8517