Healthcare Provider Details

I. General information

NPI: 1124084694
Provider Name (Legal Business Name): GROVER FERDINAND SCHLEIFER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E. REELFOOT AVE. STE 103
UNION CITY TN
38261-6048
US

IV. Provider business mailing address

1720 E. REELFOOT AVE. STE 103
UNION CITY TN
38261-6048
US

V. Phone/Fax

Practice location:
  • Phone: 731-886-1240
  • Fax: 731-886-1234
Mailing address:
  • Phone: 731-886-1240
  • Fax: 731-886-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: