Healthcare Provider Details

I. General information

NPI: 1811398944
Provider Name (Legal Business Name): RENATUS PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 KNIGHT ARNOLD RD
MEMPHIS TN
38118-3035
US

IV. Provider business mailing address

716 W BROOKHAVEN CIR
MEMPHIS TN
38117-4504
US

V. Phone/Fax

Practice location:
  • Phone: 901-267-9821
  • Fax:
Mailing address:
  • Phone: 901-267-9821
  • 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
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD NATHANIEL DONLON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 901-267-9821