Organization
SHEA CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R GROSS (ADMINISTRATOR)
(901) 761-9720
Entity
Organization
Contact information
Practice address
6133 POPLAR PIKE, MEMPHIS, TN 38119-4707
(901) 761-9720
(901) 683-8440
Mailing address
PO BOX 17987, MEMPHIS, TN 38187-0987
(901) 761-9720
(901) 683-8440
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/18/2006
Last updated
04/24/2009
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