| NPI | 1326642372 |
|---|---|
| Doing Business As | IDENTITY HORMONES LLC |
| Entity Type | Organization |
| Authorized Contact | TEAH MICHELLE SMITH Credentialing Manager 901-205-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2023-11-13 |