Healthcare Provider Details

I. General information

NPI: 1144835539
Provider Name (Legal Business Name): MEMPHIS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 11/05/2021
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 WINCHESTER RD
MEMPHIS TN
38115-4711
US

IV. Provider business mailing address

5818 WINCHESTER RD
MEMPHIS TN
38115-4711
US

V. Phone/Fax

Practice location:
  • Phone: 901-590-2202
  • Fax: 901-433-9326
Mailing address:
  • Phone: 901-590-2022
  • Fax: 901-433-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAMARIS DAVIS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 901-590-2202