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General NPI Number Information
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NPI Number | 1104640564
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Entity Type | Organization
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Legal Business Name | A1 FAMILY PHYSICIANS
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 890 GARLAND ST
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City | MEMPHIS
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State | TN
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Zip | 38107-4429
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Country | US
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Telephone | 901-673-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 890 GARLAND ST
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City | MEMPHIS
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State | TN
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Zip | 38107-4429
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Country | US
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Telephone | 901-643-3556
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA L IVORY FULLER
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Credential | CPC
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Telephone | 901-673-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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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 | 207RN0300X
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Taxonomy Name | Nephrology 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 | 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 #6
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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 #7
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 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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