Individual
LIDEADERICK LAMAR GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
3030 COVINGTON PIKE STE 200, MEMPHIS, TN 38128-5048
(901) 266-8760
Mailing address
2537 PRINCETON AVE, MEMPHIS, TN 38112-2726
(901) 483-4889
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
40177
TN
Other
Enumeration date
01/09/2024
Last updated
01/03/2026
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