MEDICARE: DR. BRENDA MOZETTE HARDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD0000020350	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4041571	OTHER	TN	BLUECROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538176805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA MOZETTE HARDY M.D.

Provider Business Mailing Address
First Line	:	2900 KIRBY RD
Second Line	:	SUITE 11
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8221
Country	:	US
Telephone Number	:	901-345-4640
Fax Number	:	901-399-7973

Provider Business Practice Location Address
First Line	:	2900 KIRBY RD
Second Line	:	SUITE 11
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8221
Country	:	US
Telephone Number	:	901-345-4640
Fax Number	:	901-399-7973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/29/2012

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