Provider Demographics
NPI:1487025524
Name:ACUPUNCTURE AND HEALING ARTS MEDICAL GROUP
Entity Type:Organization
Organization Name:ACUPUNCTURE AND HEALING ARTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:901-763-0909
Mailing Address - Street 1:5575 POPLAR AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3857
Mailing Address - Country:US
Mailing Address - Phone:901-763-0909
Mailing Address - Fax:
Practice Address - Street 1:5575 POPLAR AVE STE 702
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3857
Practice Address - Country:US
Practice Address - Phone:901-763-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty