Healthcare Provider Details

I. General information

NPI: 1841006129
Provider Name (Legal Business Name): BAPTIST MEMORIAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 POPLAR AVE
MEMPHIS TN
38117-4419
US

IV. Provider business mailing address

4625 POPLAR AVE
MEMPHIS TN
38117-4419
US

V. Phone/Fax

Practice location:
  • Phone: 901-227-4020
  • Fax: 901-227-4023
Mailing address:
  • Phone: 901-227-4020
  • Fax: 901-227-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREGORY M DUCKETT
Title or Position: EVP CLO
Credential:
Phone: 901-227-5233