Healthcare Provider Details

I. General information

NPI: 1578804142
Provider Name (Legal Business Name): BMG FAMILY PHYSICIANS GROUP FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 WINCHESTER RD STE 100
MEMPHIS TN
38125-2202
US

IV. Provider business mailing address

2859 VAN LEER DR
MEMPHIS TN
38133-4935
US

V. Phone/Fax

Practice location:
  • Phone: 901-257-9500
  • Fax:
Mailing address:
  • Phone: 901-751-5513
  • Fax: 901-751-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24112
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05911
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1314
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17471
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17737
License Number StateTN

VIII. Authorized Official

Name: GREGORY DUCKETT
Title or Position: VICE PRESIDENT
Credential:
Phone: 901-227-4068