| East Memphis Neurology Clinic Pllc | |
|
6005 Park Ave Ste 828b Memphis TN 38119-5223 | |
| (901) 899-5008 | |
| Not Available |
| Full Name | East Memphis Neurology Clinic Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6005 Park Ave Ste 828b, Memphis, Tennessee |
| Authorized Official Name and Position | Monisha Dutta (MEMBER) |
| Authorized Official Contact | 9018995008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Memphis Neurology Clinic Pllc 6005 Park Ave Ste 828b Memphis TN 38119-5223 Ph: (901) 377-8727 | East Memphis Neurology Clinic Pllc 6005 Park Ave Ste 828b Memphis TN 38119-5223 Ph: (901) 899-5008 |
| NPI Number | 1275262008 |
|---|---|
| Provider Enumeration Date | 06/07/2022 |
| Last Update Date | 06/07/2022 |
| Certification Date | 06/07/2022 |
| Medicare PECOS PAC ID | 6406237692 |
|---|---|
| Medicare Enrollment ID | O20220719003366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275262008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Monisha Dutta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164634978 PECOS PAC ID: 3678601044 Enrollment ID: I20100505000339 |
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