Individual
MRS. ANGELA MARIE CISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
4646 POPLAR AVE, SUITE 100, MEMPHIS, TN 38117-4426
(901) 762-0125
(901) 818-3001
Mailing address
4646 POPLAR AVE, SUITE 100, MEMPHIS, TN 38117-4426
(901) 762-0125
(901) 818-3001
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
01274
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1726
STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS
TN
Enumeration date
09/13/2012
Last updated
11/08/2016
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