Healthcare Provider Details

I. General information

NPI: 1083351027
Provider Name (Legal Business Name): MY DOCTORS MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6385 STAGE RD STE 2
BARTLETT TN
38134-3740
US

IV. Provider business mailing address

6385 STAGE RD STE 2
BARTLETT TN
38134-3740
US

V. Phone/Fax

Practice location:
  • Phone: 901-409-7562
  • Fax:
Mailing address:
  • Phone: 901-409-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ALI NAQVI
Title or Position: MEMBER/MANAGER
Credential: MD
Phone: 901-409-7562