Provider Demographics
NPI:1972723336
Name:UNIVERSITY OF TENNESSEE, MEMPHIS
Entity Type:Organization
Organization Name:UNIVERSITY OF TENNESSEE, MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-448-5364
Mailing Address - Street 1:11168 BERNADETTE COVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002
Mailing Address - Country:US
Mailing Address - Phone:901-485-6388
Mailing Address - Fax:
Practice Address - Street 1:UT COLLEGE OF MEDICINE, 920 MADISON AVENUE SUITE C50
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163
Practice Address - Country:US
Practice Address - Phone:901-448-5364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty