Healthcare Provider Details

I. General information

NPI: 1447124482
Provider Name (Legal Business Name): FAMILY MEDICINE WITH SURGICAL OBSTETRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5896 ESSEX CT APT 3
MEMPHIS TN
38119-5708
US

IV. Provider business mailing address

5896 ESSEX CT APT 3
MEMPHIS TN
38119-5708
US

V. Phone/Fax

Practice location:
  • Phone: 731-630-0898
  • Fax: 901-425-9741
Mailing address:
  • Phone: 731-630-0898
  • Fax: 901-425-9741

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: JOSHUA ECHEVERRIA
Title or Position: OWNER
Credential: MD
Phone: 901-491-0868