Healthcare Provider Details

I. General information

NPI: 1861719445
Provider Name (Legal Business Name): TOTAL HEATLH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4299 ELVIS PRESLEY B;VD.
MEMPHIS TN
38116-6435
US

IV. Provider business mailing address

PO BOX 30384
MEMPHIS TN
38130-0384
US

V. Phone/Fax

Practice location:
  • Phone: 901-332-5873
  • Fax:
Mailing address:
  • Phone: 901-332-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13959
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18656
License Number StateTN

VIII. Authorized Official

Name: RICKEY HUGH HUDSON SR.
Title or Position: OWNER
Credential: MD
Phone: 901-332-5873