Healthcare Provider Details

I. General information

NPI: 1518196393
Provider Name (Legal Business Name): WHEE DAVIS FITNESS & HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8076 MISTY MEADOWS LN
MEMPHIS TN
38125-2441
US

IV. Provider business mailing address

8076 MISTY MEADOWS LN
MEMPHIS TN
38125-2441
US

V. Phone/Fax

Practice location:
  • Phone: 901-315-4325
  • Fax:
Mailing address:
  • Phone: 901-315-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number109003480
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number109003480
License Number StateTN

VIII. Authorized Official

Name: SCHRICE DAVIS
Title or Position: FNP
Credential:
Phone: 901-461-7634