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General NPI Number Information
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NPI Number | 1164102133
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Entity Type | Organization
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Legal Business Name | LARAYA FAMILY MEDICINE - MEDICINA FAMILAR LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 6570 STAGE RD STE 100
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City | BARTLETT
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State | TN
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Zip | 38134-2839
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Country | US
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Telephone | 901-949-2316
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 931263
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City | ATLANTA
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State | GA
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Zip | 31193-1263
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Country | US
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Telephone | 901-949-2316
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE ARIA GHARAVI LARAYA
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Credential | MD
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Telephone | 901-949-2316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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