Individual
MR. RUNNIE DEWAYNE JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
996 PALMER RD, MEMPHIS, TN 38116-7724
(980) 133-2040
(901) 332-0402
Mailing address
996 PALMER RD, MEMPHIS, TN 38116-7724
(901) 332-0402
(901) 332-0402
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
52362989
TN
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
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