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General NPI Number Information
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NPI Number | 1336871904
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Entity Type | Individual
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Provider Name | CHRIS EDENS MARCELLUS PA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1417 MONROE AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-3634
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Country | US
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Telephone | 901-296-9400
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Fax | 901-272-0820
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Provider Business Mailing Address
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Address Line | PO BOX 22403
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City | BELFAST
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State | ME
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Zip | 04915-4476
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Country | US
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Telephone | 888-402-7256
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Fax | 888-902-1099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5687
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License Number State | TN
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