Healthcare Provider Details

I. General information

NPI: 1053725564
Provider Name (Legal Business Name): MUFADDAL NAJMUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

5301 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7542
US

V. Phone/Fax

Practice location:
  • Phone: 901-227-5135
  • Fax:
Mailing address:
  • Phone: 615-221-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1017354
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number2019032201
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2019032201
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number71126
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: