Individual
SHELBY AVENT LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 226-0340
(901) 226-0349
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(901) 227-7015
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
70822
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2019
Last updated
04/23/2024
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