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General NPI Number Information
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NPI Number | 1144835539
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Entity Type | Organization
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Legal Business Name | MEMPHIS FAMILY CARE
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 5818 WINCHESTER RD
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City | MEMPHIS
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State | TN
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Zip | 38115-4711
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Country | US
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Telephone | 901-590-2202
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Fax | 901-433-9326
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Provider Business Mailing Address
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Address Line | 5818 WINCHESTER RD
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City | MEMPHIS
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State | TN
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Zip | 38115-4711
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Country | US
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Telephone | 901-590-2022
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Fax | 901-433-9326
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | DAMARIS DAVIS
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Credential |
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Telephone | 901-590-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) 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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 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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