Healthcare Provider Details

I. General information

NPI: 1487876017
Provider Name (Legal Business Name): NATHANIEL F. N. STOIKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 WALNUT GROVE RD
MEMPHIS TN
38120
US

IV. Provider business mailing address

1407 UNION AVE STE 700
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8530
  • Fax: 901-302-2530
Mailing address:
  • Phone: 901-866-8360
  • Fax: 901-302-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2010003271
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47375
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-14225
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: