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1720859762
LIDEADERICK LAMAR GREGORY
MEMPHIS, TN
NPI
1720859762
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
163WP0808X Registered Nurse, Psych/Mental Health
(Licence: TN 239601)
Enumeration Date
2024-01-09
Last Update Date
2024-01-09
Business Address
LIDEADERICK LAMAR GREGORY
1030 JEFFERSON AVE
MEMPHIS, TN 38104-2127
Phone number: 901-523-8990
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Mailing Address
LIDEADERICK LAMAR GREGORY
2537 PRINCETON AVE
MEMPHIS, TN 38112-2726
Phone number: 901-483-4889
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