Healthcare Provider Details

I. General information

NPI: 1447620901
Provider Name (Legal Business Name): JIM PANG MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CENTERVIEW PKWY STE 301
CORDOVA TN
38018-4131
US

IV. Provider business mailing address

8000 CENTERVIEW PKWY STE 301
CORDOVA TN
38018-4131
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-4900
  • Fax: 901-752-4902
Mailing address:
  • Phone: 901-752-4900
  • Fax: 901-752-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number017659
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ035474
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: JENNIFER HAMILTON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 901-752-4900