Healthcare Provider Details

I. General information

NPI: 1508656422
Provider Name (Legal Business Name): MATERNALLY YOURS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 310
MEMPHIS TN
38119-5213
US

IV. Provider business mailing address

6005 PARK AVE STE 310
MEMPHIS TN
38119-5213
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-0073
  • Fax:
Mailing address:
  • Phone: 901-763-0833
  • Fax: 901-763-3831

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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY LEANN WIGLEY
Title or Position: NP/OWNER
Credential: NP
Phone: 228-493-0073