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General NPI Number Information
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NPI Number | 1093016651
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE GROUP LLC
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1211 UNION AVE STE 200
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City | MEMPHIS
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State | TN
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Zip | 38104-6654
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Country | US
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Telephone | 901-525-0278
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 700
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City | MEMPHIS
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State | TN
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Zip | 38104-6600
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Country | US
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Telephone | 901-478-0954
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Fax | 901-937-6696
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Authorized Official
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Title or Position | MANAGER, PROVIDER ENROLLMENT
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Name | TABATHA PERRY
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Credential |
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Telephone | 901-478-0954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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