Healthcare Provider Details

I. General information

NPI: 1689171688
Provider Name (Legal Business Name): JOCK CARRINGTON LILLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

IV. Provider business mailing address

6325 HUMPHREYS BLVD
MEMPHIS TN
38120-2300
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-7700
  • Fax: 901-522-2600
Mailing address:
  • Phone: 901-522-7700
  • Fax: 901-522-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE-19154
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number34796
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number73646
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: