Healthcare Provider Details

I. General information

NPI: 1275285090
Provider Name (Legal Business Name): PATRICK JEROME TOWNSEND JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 05/19/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2693 UNION EXTENDED SUITE 100
MEMPHIS TN
38112-4403
US

IV. Provider business mailing address

8357 PRESTINE LOOP APT 203
CORDOVA TN
38018-4296
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-0843
  • Fax: 901-278-2695
Mailing address:
  • Phone: 901-500-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4871
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: