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General NPI Number Information
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NPI Number | 1285603233
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Entity Type | Individual
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Provider Name | JACINTO A HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 6490 MT MORIAH RD EXT
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City | MEMPHIS
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State | TN
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Zip | 38115-3729
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-0616
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Provider Business Mailing Address
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Address Line | 6490 MOUNT MORIAH ROAD EXT STE 200
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City | MEMPHIS
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State | TN
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Zip | 38115-3841
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-9605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 14556
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | R3093
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License Number State | AR
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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 | 12320
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License Number State | TN
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