Healthcare Provider Details

I. General information

NPI: 1184636771
Provider Name (Legal Business Name): MEMPHIS INTERNAL MEDICINE AND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE #585
MEMPHIS TN
38104-3519
US

IV. Provider business mailing address

PO BOX 40947
MEMPHIS TN
38174-0947
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-0249
  • Fax: 901-276-0996
Mailing address:
  • Phone: 901-255-5220
  • Fax: 901-255-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLISON STILES
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 901-276-0249