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General NPI Number Information
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NPI Number | 1619989621
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Entity Type | Organization
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Legal Business Name | U.S. DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1030 JEFFERSON AVE SOCIAL WORK DEPARTMENT
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City | MEMPHIS
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State | TN
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Zip | 38104-2127
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Country | US
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Telephone | 901-523-8990
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Fax | 901-577-7427
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Provider Business Mailing Address
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Address Line | 8518 OWLSWICK LN
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City | MEMPHIS
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State | TN
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Zip | 38125-4416
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Country | US
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Telephone | 901-755-2785
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Fax | 901-577-7427
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. ROBERTA RENEE BROWN
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Credential | LCSW
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Telephone | 901-523-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 3769
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License Number State | TN
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