# UNIVERSITY OF TENNESSEE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780686170
- **Authorized official:** MYRA L SULLIVAN (DIRECTOR)
- **Authorized official phone:** (901) 448-2847

## Contact information

- **Practice address:** 1301 PRIMACY PKWY, MEMPHIS, TN 38119-0213
- **Practice address phone:** (901) 448-0275
- **Practice address fax:** (901) 448-0404
- **Mailing address:** 16 BRENTSHIRE SQ, JACKSON, TN 38305-2203
- **Mailing address phone:** (731) 664-0994
- **Mailing address fax:** (731) 664-0866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | TN | Yes |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 07/21/2022