| Up-ward Aba | |
|
2068 Evelyn Ave Memphis TN 38104-5416 | |
| (901) 308-4762 | |
| (901) 234-0221 |
| Full Name | Up-ward Aba |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2068 Evelyn Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Brandee Lynn Masterson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7312341873 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Up-ward Aba 2068 Evelyn Ave Memphis TN 38104-5416 Ph: (901) 308-4762 | Up-ward Aba 2068 Evelyn Ave Memphis TN 38104-5416 Ph: (901) 308-4762 |
| NPI Number | 1023566999 |
|---|---|
| Provider Enumeration Date | 09/20/2016 |
| Last Update Date | 04/14/2021 |
| Certification Date | 04/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023566999 | NPI | - | NPPES |
| Q019056 | Medicaid | TN | |
| 1811467731 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1-14-17291 (Colorado) | Primary |
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