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General NPI Number Information
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NPI Number | 1720011679
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Entity Type | Organization
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Legal Business Name | MID-SOUTH DERMATOLOGY, PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 6644 SUMMER KNOLL CIR
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City | BARTLETT
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State | TN
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Zip | 38134-2875
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Country | US
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Telephone | 901-372-4545
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Fax | 901-372-4310
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Provider Business Mailing Address
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Address Line | 6644 SUMMER KNOLL CIR
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City | BARTLETT
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State | TN
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Zip | 38134-2875
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Country | US
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Telephone | 901-372-4545
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Fax | 901-372-4310
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALIKA TULI
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Credential | MD
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Telephone | 901-372-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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