Healthcare Provider Details

I. General information

NPI: 1235130816
Provider Name (Legal Business Name): PRI-MED INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 EXETER RD STE-2
GERMANTOWN TN
38138-2970
US

IV. Provider business mailing address

1918 EXETER RD STE-2
GERMANTOWN TN
38138-2970
US

V. Phone/Fax

Practice location:
  • Phone: 901-624-5911
  • Fax: 901-624-5637
Mailing address:
  • Phone: 901-624-5911
  • Fax: 901-624-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. MAX F GRAY
Title or Position: GENERAL MANAGEER
Credential:
Phone: 901-624-5911