MEDICARE: MICHELLE GREEN SANDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	29047	TN

General Provider Information

NPI Number	:	1083671978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GREEN SANDS MD

Provider Business Mailing Address
First Line	:	PO BOX 1000, DEPT 978
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-758-9900
Fax Number	:	901-752-2335

Provider Business Practice Location Address
First Line	:	5182 SANDERLIN AVE STE 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4354
Country	:	US
Telephone Number	:	901-685-0152
Fax Number	:	901-685-9982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2021

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