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General NPI Number Information
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NPI Number | 1417302118
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Entity Type | Individual
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Provider Name | PANRAPEE JESSE MAHAUTMR M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2016
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 901-226-3610
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 405827
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City | ATLANTA
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State | GA
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Zip | 30384-5827
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Country | US
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Telephone | 901-226-3186
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Fax | 901-226-3160
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A171379
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 82423
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 62337
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301512827
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License Number State | MI
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