Provider Demographics
NPI:1659524148
Name:SHOT NURSE-MEMPHIS, P.C.
Entity Type:Organization
Organization Name:SHOT NURSE-MEMPHIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:OVERALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-685-9999
Mailing Address - Street 1:4637 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4419
Mailing Address - Country:US
Mailing Address - Phone:901-685-9999
Mailing Address - Fax:901-767-8388
Practice Address - Street 1:4637 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4419
Practice Address - Country:US
Practice Address - Phone:901-685-9999
Practice Address - Fax:901-767-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty