| The Fatigue Clinic LLC | |
|
890 W Poplar Ave Ste 6 Collierville TN 38017-2582 | |
| (901) 221-8621 | |
| (901) 221-8631 |
| Full Name | The Fatigue Clinic LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 890 W Poplar Ave Ste 6, Collierville, Tennessee |
| Authorized Official Name and Position | Susan D Earl (OWNER/PROVIDER) |
| Authorized Official Contact | 9012218621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Fatigue Clinic LLC 890 W Poplar Ave Ste 6 Collierville TN 38017-2582 Ph: (901) 221-8621 | The Fatigue Clinic LLC 890 W Poplar Ave Ste 6 Collierville TN 38017-2582 Ph: (901) 221-8621 |
| NPI Number | 1962779645 |
|---|---|
| Provider Enumeration Date | 11/22/2011 |
| Last Update Date | 08/13/2020 |
| Certification Date | 08/13/2020 |
| Medicare PECOS PAC ID | 2769658681 |
|---|---|
| Medicare Enrollment ID | O20111227000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962779645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 12687 (Tennessee) | Primary |
| Provider Name | Susan D Earl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093931719 PECOS PAC ID: 0345321196 Enrollment ID: I20100928001248 |
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