Provider Demographics
NPI:1790798833
Name:MEEKS, MILLICENT A (RD)
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:A
Last Name:MEEKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GROVE DALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2009
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:901-577-7434
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:DEPARTMENT 120
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7434
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered