Healthcare Provider Details

I. General information

NPI: 1023011236
Provider Name (Legal Business Name): ELISABETH E ADDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PLACE., MS 0515 ST. JUDE CHILDREN'S RESEARCH HOSPITAL
MEMPHIS TN
38105
US

IV. Provider business mailing address

262 DANNY THOMAS PLACE., MS 0515 ST. JUDE CHILDREN'S RESEARCH HOSPITAL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3006
  • Fax: 901-595-3842
Mailing address:
  • Phone: 901-595-3006
  • Fax: 901-595-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number31812
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: