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General NPI Number Information
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NPI Number | 1023158185
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Entity Type | Organization
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Legal Business Name | PERIODONTAL ASSOCIATES OF MEMPHIS
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6268 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-761-3770
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Fax | 901-761-3775
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Provider Business Mailing Address
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Address Line | 6268 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-761-3770
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Fax | 901-761-3775
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BARBARA F PATTON
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Credential |
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Telephone | 901-761-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS7731
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License Number State | TN
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