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General NPI Number Information
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NPI Number | 1801896881
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Entity Type | Individual
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Provider Name | ELBERT EDWIN HINES III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 6263 POPLAR AVE STE 1052
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City | MEMPHIS
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State | TN
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Zip | 38119-4736
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Country | US
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Telephone | 901-761-6157
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Fax | 901-213-4513
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Provider Business Mailing Address
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Address Line | 6263 POPLAR AVE STE 1052
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City | MEMPHIS
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State | TN
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Zip | 38119-4736
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Country | US
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Telephone | 901-761-6157
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Fax | 901-761-4145
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD15653
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License Number State | TN
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