Provider Demographics
NPI:1801301296
Name:ARCHIE, TEARESSIE DONSHI
Entity type:Individual
Prefix:MS
First Name:TEARESSIE
Middle Name:DONSHI
Last Name:ARCHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 ROYALCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-6438
Mailing Address - Country:US
Mailing Address - Phone:901-421-0032
Mailing Address - Fax:
Practice Address - Street 1:4064 ROYALCREST DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-6438
Practice Address - Country:US
Practice Address - Phone:901-421-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170006544172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver