Healthcare Provider Details

I. General information

NPI: 1790735124
Provider Name (Legal Business Name): TAMARA P FOLZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BROOKFIELD ROAD 2ND FLOOR
MEMPHIS TN
38119
US

IV. Provider business mailing address

1102 BROOKFIELD ROAD 2ND FLOOR
MEMPHIS TN
38119
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-1880
  • Fax: 901-683-2048
Mailing address:
  • Phone: 901-761-1880
  • Fax: 901-683-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number32112
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number032112
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: