Healthcare Provider Details

I. General information

NPI: 1497378681
Provider Name (Legal Business Name): JAYATI PAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 07/11/2023
Certification Date: 06/08/2023
Deactivation Date: 01/18/2022
Reactivation Date: 09/07/2022

III. Provider practice location address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

850 POPLAR AVE BLDG 2
MEMPHIS TN
38105-4607
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5674
  • Fax: 901-287-6804
Mailing address:
  • Phone: 901-287-5674
  • Fax: 901-287-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67396
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: