Healthcare Provider Details

I. General information

NPI: 1316961931
Provider Name (Legal Business Name): METRO MEMPHIS MEDICAL SPECIALIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 KNIGHT ARNOLD RD #420
MEMPHIS TN
38118-3035
US

IV. Provider business mailing address

3960 KNIGHT ARNOLD RD #420
MEMPHIS TN
38118-3035
US

V. Phone/Fax

Practice location:
  • Phone: 901-366-3883
  • Fax: 901-366-3887
Mailing address:
  • Phone: 901-366-3883
  • Fax: 901-366-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: KENNETH W HARRIS
Title or Position: OWNER
Credential: MD
Phone: 901-366-3883