Provider Demographics
NPI:1164910758
Name:URBAN ALPHA
Entity Type:Organization
Organization Name:URBAN ALPHA
Other - Org Name:URBAN ALPHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:901-265-8517
Mailing Address - Street 1:6286 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7629
Mailing Address - Country:US
Mailing Address - Phone:901-265-8517
Mailing Address - Fax:901-339-6304
Practice Address - Street 1:6286 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7629
Practice Address - Country:US
Practice Address - Phone:901-265-8517
Practice Address - Fax:901-339-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory