Healthcare Provider Details

I. General information

NPI: 1073594909
Provider Name (Legal Business Name): GUY V TEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

PO BOX 535
BRIGHTON TN
38011-0535
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-5000
  • Fax:
Mailing address:
  • Phone: 770-317-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number047541
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number43045
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43045
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: