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General NPI Number Information
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NPI Number | 1376095596
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Entity Type | Organization
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Legal Business Name | DR. ANDREA'S MEDICAL & WEIGHT LOSS CLINIC, PLLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 8317 CORDOVA RD SUITE 201
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City | CORDOVA
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State | TN
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Zip | 38016-2088
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Country | US
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Telephone | 901-573-6765
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Fax |
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Provider Business Mailing Address
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Address Line | 8317 CORDOVA RD SUITE 201
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City | CORDOVA
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State | TN
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Zip | 38016-2088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDRE WALKER
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Credential | DNP, FNP-C
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Telephone | 901-573-6765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | APN0000011998
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License Number State | TN
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