Individual
RHEA LAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7655 POPLAR AVE STE 240, GERMANTOWN, TN 38138-3957
(901) 758-7970
(901) 266-6425
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
6293
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/09/2023
Last updated
12/30/2024
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