Individual
LATASIA TEDNORIA BRUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
2574 FRAYSER BLVD, MEMPHIS, TN 38127-5829
(901) 301-4361
(865) 342-0121
Mailing address
6350 W ANDREW JOHNSON HWY, TALBOTT, TN 37877-8605
(800) 355-3565
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/06/2018
Last updated
04/06/2018
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