Healthcare Provider Details

I. General information

NPI: 1750416319
Provider Name (Legal Business Name): LAURELWOOD PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SANDERLIN AVE
MEMPHIS TN
38117-4332
US

IV. Provider business mailing address

5050 SANDERLIN AVE
MEMPHIS TN
38117-4332
US

V. Phone/Fax

Practice location:
  • Phone: 901-507-6907
  • Fax: 901-761-1979
Mailing address:
  • Phone: 901-507-6907
  • Fax: 901-761-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VIOLET V WILLIAMSON
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 901-507-6907