Provider Demographics
NPI:1891927356
Name:EARL, MIA D (PHD, MPH, CHES)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:D
Last Name:EARL
Suffix:
Gender:F
Credentials:PHD, MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 NANJACK CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2058
Mailing Address - Country:US
Mailing Address - Phone:901-240-0980
Mailing Address - Fax:
Practice Address - Street 1:5731 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2058
Practice Address - Country:US
Practice Address - Phone:901-240-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRCR0000000163173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist