MEDICARE: G J PRYOR

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	261Q00000X	Clinic/Center	DS3535	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1538331533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G J PRYOR

Provider Business Mailing Address
First Line	:	2410 CHELSEA AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38108-1515
Country	:	US
Telephone Number	:	901-458-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 CHELSEA AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38108-1515
Country	:	US
Telephone Number	:	901-458-1118
Fax Number	:	901-454-1983

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. GLORIA JEAN PRYOR
Credential	:	DDS
Telephone Number	:	901-458-1118

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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