Healthcare Provider Details

I. General information

NPI: 1881383958
Provider Name (Legal Business Name): DR. RAPHAEL SAMUEL FIGUEROA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SKYLINE DR
JACKSON TN
38301-3923
US

IV. Provider business mailing address

257 BANCORP SOUTH PKWY
JACKSON TN
38305-7582
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-5000
  • Fax:
Mailing address:
  • Phone: 731-541-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77600
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: