Healthcare Provider Details

I. General information

NPI: 1902823487
Provider Name (Legal Business Name): PEDIATRIC PARTNERS OF MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 MT. MORIAH ROAD EXTENDED SUITE 13
MEMPHIS TN
38115
US

IV. Provider business mailing address

PO BOX 341107
MEMPHIS TN
38184-1107
US

V. Phone/Fax

Practice location:
  • Phone: 901-366-0080
  • Fax: 901-366-0070
Mailing address:
  • Phone: 901-366-0080
  • Fax: 901-366-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORAH D WATSON
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 901-366-0080