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General NPI Number Information
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NPI Number | 1770798332
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TN CYTOGENETICS LAB-MEMPHIS
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711 JEFFERSON AVE SUITE 523
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City | MEMPHIS
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State | TN
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Zip | 38105-5003
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Country | US
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Telephone | 901-448-6676
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Fax | 901-448-4117
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Provider Business Mailing Address
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Address Line | 711 JEFFERSON AVE SUITE 523
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City | MEMPHIS
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State | TN
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Zip | 38105-5003
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Country | US
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Telephone | 901-448-6676
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Fax | 901-448-4117
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Authorized Official
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Title or Position | DIRECTOR, CYTOGENETICS LABORATORY
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Name | DR. AVIRACHAN THARAPEL
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Credential | PH.D.
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Telephone | 901-448-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 0000002103
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License Number State | TN
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