Healthcare Provider Details

I. General information

NPI: 1871051474
Provider Name (Legal Business Name): SHELBY COUNTY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 KIRBY GATE BLVD
MEMPHIS TN
38119-2673
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR STE 320
ATLANTA GA
30328-5834
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-0772
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA ROSE HALE
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 770-874-5439