1962030221 NPI number — MRS. ALLISON BURGE CLAYTON RD

Table of content: MRS. ALLISON BURGE CLAYTON RD (NPI 1962030221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962030221 NPI number — MRS. ALLISON BURGE CLAYTON RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAYTON
Provider First Name:
ALLISON
Provider Middle Name:
BURGE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962030221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N DUNLAP
Provider Second Line Business Mailing Address:
NUTRITION THERAPY DEPT, 1ST FLOOR RESEARCH TOWER
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-287-6242
Provider Business Mailing Address Fax Number:
901-287-5123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 N DUNLAP
Provider Second Line Business Practice Location Address:
NUTRITION THERAPY DEPT, 1ST FLOOR RESEARCH TOWER
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-287-6242
Provider Business Practice Location Address Fax Number:
901-287-5123
Provider Enumeration Date:
03/31/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  2599 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)