Individual
FANNIE JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2579 DOUGLASS AVE, MEMPHIS, TN 38114-2532
(901) 576-3224
Mailing address
2220 UNION AVE, MEMPHIS, TN 38104-4315
(901) 567-3554
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/18/2022
Last updated
02/18/2022
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