Healthcare Provider Details

I. General information

NPI: 1033482906
Provider Name (Legal Business Name): HARVEST HEALTH SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 GREEN TREE CV SUITE 203
COLLIERVILLE TN
38017-2562
US

IV. Provider business mailing address

574 GREEN TREE CV SUITE 203
COLLIERVILLE TN
38017-2562
US

V. Phone/Fax

Practice location:
  • Phone: 901-850-2233
  • Fax: 901-850-9911
Mailing address:
  • Phone: 901-850-2233
  • Fax: 901-850-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L. CARMACK
Title or Position: OWNER
Credential:
Phone: 901-850-2233