Provider Demographics
NPI:1669018859
Name:CHILDS, ANGELA CARROLL (BS, RPSGT, RST, CCSH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CARROLL
Last Name:CHILDS
Suffix:
Gender:F
Credentials:BS, RPSGT, RST, CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 ORR RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4332
Mailing Address - Country:US
Mailing Address - Phone:901-867-7001
Mailing Address - Fax:901-867-1918
Practice Address - Street 1:5050 POPLAR AVE STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0300
Practice Address - Country:US
Practice Address - Phone:901-820-3444
Practice Address - Fax:901-937-3345
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN433246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other