Healthcare Provider Details

I. General information

NPI: 1912242405
Provider Name (Legal Business Name): CHARLOTTE DEFLUMERE, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD SUITE 110
MEMPHIS TN
38119-0800
US

IV. Provider business mailing address

1068 CRESTHAVEN RD SUITE 110
MEMPHIS TN
38119-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-405-6470
  • Fax: 901-747-2338
Mailing address:
  • Phone: 901-405-6470
  • Fax: 901-747-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number20004
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20004
License Number StateTN

VIII. Authorized Official

Name: CHARLOTTE A DEFLUMERE
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 901-405-6470