Healthcare Provider Details

I. General information

NPI: 1518094085
Provider Name (Legal Business Name): TOTAL FOOT CARE, INC. OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MADISON AVE
MEMPHIS TN
38104-2226
US

IV. Provider business mailing address

1204 MADISON AVE
MEMPHIS TN
38104-2226
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-7698
  • Fax: 901-272-2045
Mailing address:
  • Phone: 901-523-7698
  • Fax: 901-272-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number652
License Number StateTN

VIII. Authorized Official

Name: DR. TYRONE TEAKO DAVIS
Title or Position: PHYSICIAN
Credential: DPM
Phone: 901-523-7698