Healthcare Provider Details

I. General information

NPI: 1508445693
Provider Name (Legal Business Name): TACHELE C CANDIA ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

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: 901-287-7337
  • Fax: 901-287-4646
Mailing address:
  • Phone: 901-287-5594
  • Fax: 901-287-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71726
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: