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General NPI Number Information
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NPI Number | 1427064880
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TENNESSEE
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 920 MADISON AVE STE 939
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City | MEMPHIS
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State | TN
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Zip | 38103-3438
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Country | US
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Telephone | 901-448-6511
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Fax | 901-448-3844
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Provider Business Mailing Address
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Address Line | 920 MADISON AVE STE 939
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City | MEMPHIS
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State | TN
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Zip | 38103-3438
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Country | US
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Telephone | 901-448-6511
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Fax | 901-448-3844
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRUCE KEISLING
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Credential | PHD
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Telephone | 901-448-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | LM222M20956033
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License Number State | TN
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