Healthcare Provider Details

I. General information

NPI: 1972644789
Provider Name (Legal Business Name): ALPHA MAXX HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE SUITE 802
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

2095 EXETER RD SUITE 80
GERMANTOWN TN
38138-3946
US

V. Phone/Fax

Practice location:
  • Phone: 901-259-5341
  • Fax: 901-259-5344
Mailing address:
  • Phone: 901-259-5341
  • Fax: 901-259-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES GREEN JR.
Title or Position: PRESIDENT
Credential:
Phone: 901-259-5341