Healthcare Provider Details

I. General information

NPI: 1740470863
Provider Name (Legal Business Name): PHOENIX NEUROSURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 S REX RD
MEMPHIS TN
38119-3821
US

IV. Provider business mailing address

5673 S REX RD
MEMPHIS TN
38119-3821
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-6400
  • Fax: 901-276-6440
Mailing address:
  • Phone: 901-276-6400
  • Fax: 901-276-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DENISE RENEE PURIFOY
Title or Position: OFFICE MANAGER
Credential:
Phone: 901-276-6453