Basic Information
| Provider Information | |||||||||
| NPI: | 1619989621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | U.S. DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8518 OWLSWICK LN | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381254416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017552785 | ||||||||
| FaxNumber: | 9015777427 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | SOCIAL WORK DEPARTMENT | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
| FaxNumber: | 9015777427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | ROBERTA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 9015238990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 3769 | TN | Y | Hospitals | Psychiatric Hospital |
No ID Information.