Doctor Name: | MR. RUNNIE DEWAYNE JEFFERSON |
NPI Number: | 1225366487 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 52362989 |
Business Practice Address: | 996 Palmer Rd Memphis, TN - 381167724 |
Business Phone Number: | 9801332040 |
Business Fax Number: | 9013320402 |
Mailing Address: | 996 Palmer Rd, MEMPHIS |
State: | TN |
Postal Code: | 381167724 |
Phone Number: | 9013320402 |
Fax Number: | 9013320402 |
NPI Enumeration Date: | 11/30/2009 |
NPI Last Update Date: | 11/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | 52362989 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |