Healthcare Provider Details

I. General information

NPI: 1689855124
Provider Name (Legal Business Name): PARK HIGHLAND MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 PARK AVE
MEMPHIS TN
38111-6633
US

IV. Provider business mailing address

PO BOX 17962
MEMPHIS TN
38187-0962
US

V. Phone/Fax

Practice location:
  • Phone: 901-324-3984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDHA PRASAD
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 901-324-3984