Healthcare Provider Details

I. General information

NPI: 1477291060
Provider Name (Legal Business Name): EDWARD RICHARD MORAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 POPLAR AVE STE 201
GERMANTOWN TN
38138-3806
US

IV. Provider business mailing address

920 MADISON AVE
MEMPHIS TN
38103-3438
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-3565
  • Fax:
Mailing address:
  • Phone: 901-287-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74343
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number74343
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: