Healthcare Provider Details

I. General information

NPI: 1457344145
Provider Name (Legal Business Name): FAMILY PHYSICIANS GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 VAN LEER DR
MEMPHIS TN
38133-4935
US

IV. Provider business mailing address

2859 VAN LEER DR
MEMPHIS TN
38133-4935
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-6963
  • Fax: 901-751-5541
Mailing address:
  • Phone: 901-752-6963
  • Fax: 901-751-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES J WOODALL
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 901-751-5536