Healthcare Provider Details

I. General information

NPI: 1053346064
Provider Name (Legal Business Name): UROLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 WOLF RIVER BLVD STE 200
GERMANTOWN TN
38138-1778
US

IV. Provider business mailing address

7550 WOLF RIVER BLVD STE 200
GERMANTOWN TN
38138-1778
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-8158
  • Fax:
Mailing address:
  • Phone: 901-767-8158
  • Fax: 901-767-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANGIE WILSON
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 901-767-8158