Provider Demographics
NPI:1114127271
Name:HART, AUDREY RENITA
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:RENITA
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 UNION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3921
Mailing Address - Country:US
Mailing Address - Phone:901-544-0174
Mailing Address - Fax:901-544-0179
Practice Address - Street 1:1835 UNION AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3921
Practice Address - Country:US
Practice Address - Phone:901-544-0174
Practice Address - Fax:901-544-0179
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker