Provider Demographics
NPI:1326692203
Name:MANN, CLARENCE
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:
Last Name:MANN
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 1:2879 S MENDENHALL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2207
Mailing Address - Country:US
Mailing Address - Phone:901-949-1148
Mailing Address - Fax:901-260-2674
Practice Address - Street 1:2879 S MENDENHALL RD STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2207
Practice Address - Country:US
Practice Address - Phone:901-949-1148
Practice Address - Fax:901-260-2674
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL0000000017871251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health