=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376738906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT PRIMARY CARE OF MEMPHIS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2007
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6263 POPLAR AVE SUITE 1052
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-761-6157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 338
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38101-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-761-6157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMMAD I ABUTINEH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 901-761-6157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD29209
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------