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General NPI Number Information
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NPI Number | 1205173770
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Entity Type | Organization
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Legal Business Name | DUCKWORTH LABORATORIES INC.
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 1211 UNION AVE SUITE 300
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City | MEMPHIS
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State | TN
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Zip | 38104-6638
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Country | US
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Telephone | 901-725-7551
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Fax | 901-725-9721
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE SUITE 300
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City | MEMPHIS
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State | TN
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Zip | 38104-6638
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Country | US
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Telephone | 901-725-7551
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Fax | 901-725-9721
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Authorized Official
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Title or Position | COMPLIANCE OFFICETR
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Name | DOROTHY L BLACK
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Credential | CHCO
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Telephone | 901-725-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 3282
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License Number State | TN
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