Provider Demographics
NPI:1689171688
Name:LILLARD, JOCK
Entity Type:Individual
Prefix:
First Name:JOCK
Middle Name:
Last Name:LILLARD
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 1:847 MONROE AVENUE SUITE 427
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2733
Mailing Address - Country:US
Mailing Address - Phone:901-448-6375
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-3415
Practice Address - Country:US
Practice Address - Phone:448-763-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program