Organization
LIFESTYLE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVORY LEE TAYLOR ED.D (CEO)
(901) 794-3707
Entity
Organization
Contact information
Practice address
3333 E SHELBY DR, SUITE 3, MEMPHIS, TN 38118-7256
(901) 794-3707
(901) 794-3690
Mailing address
3333 E SHELBY DR, SUITE 3, MEMPHIS, TN 38118-7256
(901) 794-3707
(901) 794-3690
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000793975
SCERETARY OF STATE CONTROL NUMBER
TN
Enumeration date
06/19/2015
Last updated
06/19/2015
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