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General NPI Number Information
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NPI Number | 1366472144
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Entity Type | Individual
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Provider Name | CARLA LYN-BOSWELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 4066 SUMMER AVE
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City | MEMPHIS
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State | TN
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Zip | 38122-5225
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Country | US
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Telephone | 901-452-7391
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 COVINGTON PIKE STE 100
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City | MEMPHIS
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State | TN
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Zip | 38128-5049
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Country | US
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Telephone | 901-383-8889
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Fax | 901-384-6309
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD40403
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License Number State | TN
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