Healthcare Provider Details

I. General information

NPI: 1356432355
Provider Name (Legal Business Name): MEMPHIS INTERNISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 KATE BOND RD
BARTLETT TN
38133-4004
US

IV. Provider business mailing address

3294 POPLAR AVE SUITE 100
MEMPHIS TN
38111-4649
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-8671
  • Fax:
Mailing address:
  • Phone: 901-362-8671
  • Fax: 901-458-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHMOOD ALI
Title or Position: OWNER, CEO
Credential: MD
Phone: 901-362-8671