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NPI Code Detail

MEDICARE: WILMER E AMOS PH.D.

MEDICARE: WILMER E AMOS PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist32483MS
2103TC0700XClinical PsychologistP 1201TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134100712
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILMER E AMOS PH.D.
Provider Business Mailing Address
First Line : 5384 POPLAR AVE
Second Line : SUITE 313
City : MEMPHIS
State : TN
Zip : 38119-3609
Country : US
Telephone Number : 901-237-0261
Fax Number : 901-683-2058
Provider Business Practice Location Address
First Line : 5384 POPLAR AVE
Second Line : SUITE 313
City : MEMPHIS
State : TN
Zip : 38119-3609
Country : US
Telephone Number : 901-237-0261
Fax Number : 901-683-2058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 08/01/2022

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Directions to “ WILMER E AMOS PH.D.” Practice Location

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