MEDICARE: GERIATRIC GROUP OF MEMPHIS,PLLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC GROUP OF MEMPHIS,PLLC

Provider Business Mailing Address
First Line	:	2714 UNION AVENUE EXT
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4436
Country	:	US
Telephone Number	:	901-725-0872
Fax Number	:	901-278-6934

Provider Business Practice Location Address
First Line	:	2714 UNION AVENUE EXT
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4436
Country	:	US
Telephone Number	:	901-725-0872
Fax Number	:	901-278-6934

Authorized Official
Title or Position	:	OPERATIONS MGR
Name	:	JENNY WREN MCCALLA
Credential	:
Telephone Number	:	901-725-0872

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/07/2016

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