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General NPI Number Information
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NPI Number | 1851342471
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Entity Type | Organization
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Legal Business Name | JULIA K. PUTNAM
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 256 S CAMILLA ST
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City | MEMPHIS
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State | TN
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Zip | 38104-3335
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Country | US
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Telephone | 901-528-1284
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Fax | 901-528-1289
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Provider Business Mailing Address
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Address Line | 74 SANDERS DR
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City | BRIGHTON
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State | TN
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Zip | 38011-6501
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Country | US
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Telephone | 901-268-4229
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Fax | 901-476-5638
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JULIA KNOX PUTNAM
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Credential |
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Telephone | 901-268-4229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000017768
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License Number State | TN
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