Healthcare Provider Details

I. General information

NPI: 1457622235
Provider Name (Legal Business Name): HEALTHY INDIGENT POPULATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 DELMAR
MEMPHIS TN
38105
US

IV. Provider business mailing address

PO BOX 41202
MEMPHIS TN
38174-1202
US

V. Phone/Fax

Practice location:
  • Phone: 901-213-8395
  • Fax:
Mailing address:
  • Phone: 901-213-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0603997
License Number StateTN

VIII. Authorized Official

Name: FREDERIC DUNN
Title or Position: CEO
Credential: DDS
Phone: 901-213-8395