MEDICARE: DR. YOLANDA S DRAINE DHA

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
1	332B00000X	Durable Medical Equipment & Medical Supplies		TN

General Provider Information

NPI Number	:	1467075838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOLANDA S DRAINE DHA

Provider Business Mailing Address
First Line	:	1490 UNION AVE # 125
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-3725
Country	:	US
Telephone Number	:	901-451-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 MONROE AVE # 1413
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3252
Country	:	US
Telephone Number	:	901-451-4440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/20/2020

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