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General NPI Number Information
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NPI Number | 1184322067
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Entity Type | Organization
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Legal Business Name | UROLOGY GROUP, PC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 944 STATE HIGHWAY 77
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City | MARION
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State | AR
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Zip | 72364-9004
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Country | US
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Telephone | 901-767-8158
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Fax |
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Provider Business Mailing Address
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Address Line | 6029 WALNUT GROVE RD STE 300
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City | MEMPHIS
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State | TN
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Zip | 38120-2112
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Country | US
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Telephone | 901-767-8158
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | LESLIE MCGOWAN
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Credential | MD
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Telephone | 901-767-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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