Healthcare Provider Details

I. General information

NPI: 1134081748
Provider Name (Legal Business Name): MARTHA SANFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 AUSTIN PEAY HWY
MEMPHIS TN
38128-2502
US

IV. Provider business mailing address

76 OKEECHOBEE CIR
SANTA ROSA BEACH FL
32459-8798
US

V. Phone/Fax

Practice location:
  • Phone: 901-213-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTHA SANFORD
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 901-844-1435