Healthcare Provider Details

I. General information

NPI: 1760482434
Provider Name (Legal Business Name): PEDIATRIC EMERGENCY SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/03/2015
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 #1011
ARLINGTON TN
38002-5127
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6112
  • Fax:
Mailing address:
  • Phone: 901-317-7360
  • Fax: 901-317-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberN/A
License Number StateTN

VIII. Authorized Official

Name: DR. WILLIAM R HANNA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 901-287-6112