Healthcare Provider Details

I. General information

NPI: 1710067020
Provider Name (Legal Business Name): MEMPHIS & SHELBY COUNTY PED. GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 E SHELBY DR SUITE 317
MEMPHIS TN
38116-7260
US

IV. Provider business mailing address

1444 E SHELBY DR SUITE 317
MEMPHIS TN
38116-7260
US

V. Phone/Fax

Practice location:
  • Phone: 901-396-8281
  • Fax:
Mailing address:
  • Phone: 901-396-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE CARTER
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 901-396-8366