Individual
BETTY J MIRRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3085 FOUNTAINSIDE DR, SUITE 202, GERMANTOWN, TN 38138-7842
(901) 755-0550
(901) 755-0474
Mailing address
3085 FOUNTAINSIDE DR, SUITE 202, GERMANTOWN, TN 38138-7842
(901) 755-0550
(901) 755-0474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17702
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370933
—
TN
01
—
621756596
TAX ID#
TN
Enumeration date
07/19/2005
Last updated
03/08/2017
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