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General NPI Number Information
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NPI Number | 1497194864
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Entity Type | Individual
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Provider Name | AMINA DAFALLA M.D
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 681 S WHITE STATION RD
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City | MEMPHIS
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State | TN
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Zip | 38117-4560
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Country | US
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Telephone | 901-276-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 8110 N BROTHER BLVD STE 200
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City | BARTLETT
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State | TN
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Zip | 38133-2760
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Country | US
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Telephone | 901-255-5221
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101263653
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 56570
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License Number State | TN
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