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General NPI Number Information
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NPI Number | 1780686170
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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 | 08/15/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1301 PRIMACY PKWY
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City | MEMPHIS
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State | TN
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Zip | 38119-0213
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Country | US
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Telephone | 901-448-0275
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Fax | 901-448-0404
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Provider Business Mailing Address
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Address Line | 16 BRENTSHIRE SQ
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City | JACKSON
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State | TN
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Zip | 38305-2203
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Country | US
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Telephone | 731-664-0994
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Fax | 731-664-0866
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Authorized Official
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Title or Position | DIRECTOR
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Name | MYRA L SULLIVAN
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Credential |
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Telephone | 901-448-2847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TN
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