Healthcare Provider Details

I. General information

NPI: 1386478949
Provider Name (Legal Business Name): PREVENTIVEMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4066 SUMMER AVE
MEMPHIS TN
38122-5262
US

IV. Provider business mailing address

4066 SUMMER AVE
MEMPHIS TN
38122-5262
US

V. Phone/Fax

Practice location:
  • Phone: 901-452-7391
  • Fax:
Mailing address:
  • Phone: 901-452-7391
  • Fax: 901-545-5088

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WRIGHT-MATTHEWS
Title or Position: CEO
Credential:
Phone: 901-201-5675