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General NPI Number Information
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NPI Number | 1164910758
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Entity Type | Organization
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Legal Business Name | URBAN ALPHA
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Dates
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Enumeration Date | 04/29/2018
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Last Update Date | 04/29/2018
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Provider Practice Location Address
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Address Line | 6286 QUINCE RD
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City | MEMPHIS
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State | TN
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Zip | 38119-7629
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Country | US
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Telephone | 901-265-8517
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Fax | 901-339-6304
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Provider Business Mailing Address
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Address Line | 6286 QUINCE RD
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City | MEMPHIS
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State | TN
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Zip | 38119-7629
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Country | US
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Telephone | 901-265-8517
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Fax | 901-339-6304
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBORAH DONNELL WILLIAMS
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Credential | PHLEBOTOMIST
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Telephone | 901-265-8517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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