Provider Demographics
NPI:1184003519
Name:CATRON, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:CATRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 STAGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3808
Mailing Address - Country:US
Mailing Address - Phone:901-825-1341
Mailing Address - Fax:
Practice Address - Street 1:6520 STAGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3808
Practice Address - Country:US
Practice Address - Phone:901-825-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000016364251E00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013205Medicaid