Organization
SUPPLEMENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA HILSON (EXECUTIVE DIRECTOR)
(901) 414-0208
Entity
Organization
Contact information
Practice address
7665 EASTERLY LN, MEMPHIS, TN 38125-4313
(901) 414-0208
Mailing address
7665 EASTERLY LN, MEMPHIS, TN 38125-4313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
TN
Other
Enumeration date
06/13/2014
Last updated
06/13/2014
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