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General NPI Number Information
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NPI Number | 1225119654
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Entity Type | Organization
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Legal Business Name | FOREST HILL FAMILY PRACTICE AND AESTHETICS P C
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 8970 WINCHESTER ROAD
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City | MEMPHIS
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State | TN
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Zip | 38125-8231
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Country | US
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Telephone | 901-794-5806
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Fax | 901-794-7922
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Provider Business Mailing Address
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Address Line | 8970 WINCHESTER ROAD
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City | MEMPHIS
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State | TN
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Zip | 38125-8231
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Country | US
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Telephone | 901-794-5806
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Fax | 901-794-7922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP GRAYER MINTZ
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Credential | M.D.
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Telephone | 901-794-5806
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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 | MD13053
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License Number State | TN
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