Healthcare Provider Details

I. General information

NPI: 1740119684
Provider Name (Legal Business Name): OCTAVIA ARNISHA QUARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 HARVEST PARK DR
MEMPHIS TN
38125-4767
US

IV. Provider business mailing address

4754 HARVEST PARK DR
MEMPHIS TN
38125-4767
US

V. Phone/Fax

Practice location:
  • Phone: 901-513-7216
  • Fax:
Mailing address:
  • Phone: 901-513-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: