Provider Demographics
NPI:1447623202
Name:CHILDS, CORDRA DENISE
Entity type:Individual
Prefix:MS
First Name:CORDRA
Middle Name:DENISE
Last Name:CHILDS
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 1:1615 CANE MEADOW CIR APT 117
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-6127
Mailing Address - Country:US
Mailing Address - Phone:901-219-6490
Mailing Address - Fax:
Practice Address - Street 1:1615 CANE MEADOW CIR APT 117
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-6127
Practice Address - Country:US
Practice Address - Phone:901-219-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator