Provider Demographics
NPI:1871095737
Name:MANN, PHYLLIS DENISE
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:DENISE
Last Name:MANN
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 1:2285 N ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8421
Mailing Address - Country:US
Mailing Address - Phone:731-298-9465
Mailing Address - Fax:
Practice Address - Street 1:2285 N ROYAL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8421
Practice Address - Country:US
Practice Address - Phone:731-298-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)