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General NPI Number Information
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NPI Number | 1285723403
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Entity Type | Organization
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Legal Business Name | PEABODY INTERNAL MEDICINE, INC.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8081 HWY . 51 NORTH
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City | MILLINGTON
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State | TN
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Zip | 38053
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Country | US
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Telephone | 901-873-4194
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Fax | 901-872-6553
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Provider Business Mailing Address
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Address Line | 8081 HWY . 51 NORTH
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City | MILLINGTON
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State | TN
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Zip | 38053
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Country | US
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Telephone | 901-873-4194
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Fax | 901-872-6553
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABDULLAH BAIG
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Credential | M.D.
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Telephone | 901-873-4194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30578
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License Number State | TN
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