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General NPI Number Information
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NPI Number | 1871051474
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Entity Type | Organization
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Legal Business Name | SHELBY COUNTY PHYSICIANS, PLLC
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 6500 KIRBY GATE BLVD
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City | MEMPHIS
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State | TN
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Zip | 38119-2673
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Country | US
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Telephone | 901-752-0772
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 NEW NORTHSIDE DR STE 320
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City | ATLANTA
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State | GA
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Zip | 30328-5834
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Country | US
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Telephone | 770-874-5400
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | MRS. LISA ROSE HALE
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Credential |
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Telephone | 770-874-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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