Healthcare Provider Details

I. General information

NPI: 1124254404
Provider Name (Legal Business Name): MICHELE KAMP FAIRCLOTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE FRANCES KAMP MD

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POPLAR AVE
GERMANTOWN TN
38138-3904
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-1290
  • Fax: 901-516-1220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23748
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48481
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48481
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23748
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: