Healthcare Provider Details

I. General information

NPI: 1982284758
Provider Name (Legal Business Name): PAIGE VICENZI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

861 WINTERFALLS TRL
CORDOVA TN
38018-7969
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax: 901-595-3842
Mailing address:
  • Phone: 817-994-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5743
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: