Healthcare Provider Details

I. General information

NPI: 1760882054
Provider Name (Legal Business Name): EAST MEMPHIS PULMONARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 KATE BOND RD
BARTLETT TN
38133-4003
US

IV. Provider business mailing address

PO BOX 217
CORDOVA TN
38088-0217
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-9895
  • Fax: 901-377-3633
Mailing address:
  • Phone: 901-681-9895
  • Fax: 901-377-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD51593
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD51593
License Number StateTN

VIII. Authorized Official

Name: DR. KAMEL MADARATY
Title or Position: OWNER
Credential: M. D.
Phone: 901-681-9895