Provider Demographics
NPI:1275262008
Name:EAST MEMPHIS NEUROLOGY CLINIC PLLC
Entity Type:Organization
Organization Name:EAST MEMPHIS NEUROLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-899-5008
Mailing Address - Street 1:6005 PARK AVE STE 828B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5223
Mailing Address - Country:US
Mailing Address - Phone:901-377-8727
Mailing Address - Fax:901-377-7309
Practice Address - Street 1:6005 PARK AVE STE 828B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5223
Practice Address - Country:US
Practice Address - Phone:901-899-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty