MEDICARE: FAMILY PHYSICIANS GROUP PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1457344145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICIANS GROUP PC

Provider Business Mailing Address
First Line	:	2859 VAN LEER DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4935
Country	:	US
Telephone Number	:	901-752-6963
Fax Number	:	901-751-5541

Provider Business Practice Location Address
First Line	:	2859 VAN LEER DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4935
Country	:	US
Telephone Number	:	901-752-6963
Fax Number	:	901-751-5541

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CHARLES J WOODALL
Credential	:
Telephone Number	:	901-751-5536

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	03/19/2008

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