Doctor Name: | AUDREY W COO |
NPI Number: | 1114928124 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MD29587 |
Business Practice Address: | 2225 Union Ave Suite 100 Memphis, TN - 381044316 |
Business Phone Number: | 9017261161 |
Business Fax Number: | 9017260161 |
Mailing Address: | 2225 Union Ave, Suite 100 MEMPHIS |
State: | TN |
Postal Code: | 381044316 |
Phone Number: | 9017261161 |
Fax Number: | 9017260161 |
NPI Enumeration Date: | 08/02/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD29587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |