Healthcare Provider Details

I. General information

NPI: 1043860448
Provider Name (Legal Business Name): 901 HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3068 COVINGTON PIKE STE 3
MEMPHIS TN
38128-5001
US

IV. Provider business mailing address

3068 COVINGTON PIKE STE 3
MEMPHIS TN
38128-5001
US

V. Phone/Fax

Practice location:
  • Phone: 901-831-6905
  • Fax: 901-364-6309
Mailing address:
  • Phone: 901-831-6905
  • Fax: 901-364-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN ROCCO MACMILLAN RODNEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 901-831-6905