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General NPI Number Information
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NPI Number | 1871453704
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Entity Type | Organization
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Legal Business Name | SOUTHERN SKY OUTPATIENT DETOX, LLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2715 KIRBY RD STE 1
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City | MEMPHIS
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State | TN
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Zip | 38119-8238
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Country | US
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Telephone | 770-659-5944
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Fax |
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Provider Business Mailing Address
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Address Line | 227 SANDY SPRINGS PL # D-298
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JONATHAN E DENKER III
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Credential |
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Telephone | 770-659-5944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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