Healthcare Provider Details

I. General information

NPI: 1740778166
Provider Name (Legal Business Name): CODY'S CENTER OF HOPE, DEDICATED PEDIATRIC CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 HORIZON LAKE DR STE 114
MEMPHIS TN
38133-8113
US

IV. Provider business mailing address

PO BOX 381442
GERMANTOWN TN
38183-1442
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-2639
  • Fax: 901-249-4563
Mailing address:
  • Phone: 901-350-2639
  • Fax: 901-249-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LORI R HOLTZMAN
Title or Position: PRESIDENT
Credential:
Phone: 901-350-2639