Organization
RAW DYMONDZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA R NICHOLS (CRANIAL PROTHESIS SPECIALIST)
(901) 896-6685
Entity
Organization
Contact information
Practice address
2096 MCPHERSON RD, MEMPHIS, TN 38116-8618
(901) 896-6685
(901) 896-6685
Mailing address
2096 MCPHERSON RD, MEMPHIS, TN 38116-8618
(901) 896-6685
(901) 896-6685
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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