Healthcare Provider Details

I. General information

NPI: 1225119654
Provider Name (Legal Business Name): FOREST HILL FAMILY PRACTICE AND AESTHETICS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8970 WINCHESTER ROAD
MEMPHIS TN
38125-8231
US

IV. Provider business mailing address

8970 WINCHESTER ROAD
MEMPHIS TN
38125-8231
US

V. Phone/Fax

Practice location:
  • Phone: 901-794-5806
  • Fax: 901-794-7922
Mailing address:
  • Phone: 901-794-5806
  • Fax: 901-794-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD13053
License Number StateTN

VIII. Authorized Official

Name: DR. PHILIP GRAYER MINTZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 901-794-5806