Healthcare Provider Details

I. General information

NPI: 1649270919
Provider Name (Legal Business Name): AMY L HERTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

5885 AIRLINE RD UNIT 1011
ARLINGTON TN
38002-5122
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6112
  • Fax:
Mailing address:
  • Phone: 901-317-7427
  • Fax: 901-317-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number21017
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: