=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972723336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF TENNESSEE, MEMPHIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UT COLLEGE OF MEDICINE, 920 MADISON AVENUE SUITE C50
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-448-5364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11168 BERNADETTE COVE
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-485-6388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | AARON HAYNES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-448-5364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------