Healthcare Provider Details

I. General information

NPI: 1912054875
Provider Name (Legal Business Name): SARA BELSCHES GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N DUNLAP ST
MEMPHIS TN
38103-2800
US

IV. Provider business mailing address

PO BOX 637
ELLENDALE TN
38029-0637
US

V. Phone/Fax

Practice location:
  • Phone: 901-572-5986
  • Fax:
Mailing address:
  • Phone: 615-507-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000044930
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: