Healthcare Provider Details

I. General information

NPI: 1871594952
Provider Name (Legal Business Name): EDWARD STEPHEN PRATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXETER RD SUITE 130
GERMANTOWN TN
38138-3922
US

IV. Provider business mailing address

2120 EXETER RD SUITE 130
GERMANTOWN TN
38138-3922
US

V. Phone/Fax

Practice location:
  • Phone: 901-507-2225
  • Fax: 901-507-7890
Mailing address:
  • Phone: 901-507-2225
  • Fax: 901-507-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD 14529
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD 14529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: