Individual
ENSAR AVDIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
930 MADISON AVE, MEMPHIS, TN 38103-3410
(901) 448-6344
Mailing address
920 MADISON AVE STE 447, MEMPHIS, TN 38103-3438
(901) 448-6344
(901) 448-6979
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
04/23/2026
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