Healthcare Provider Details

I. General information

NPI: 1114322245
Provider Name (Legal Business Name): CG& T
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W BROOKHAVEN CIR
MEMPHIS TN
38117-4503
US

IV. Provider business mailing address

721 W BROOKHAVEN CIR
MEMPHIS TN
38117-4503
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-8077
  • Fax: 901-767-8861
Mailing address:
  • Phone: 901-767-8077
  • Fax: 901-767-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HATCHCOCK
Title or Position: OWNER
Credential:
Phone: 901-767-8077