MEDICARE: WHITNEY SLADE MD, LLC

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

General Provider Information

NPI Number	:	1659600518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITNEY SLADE MD, LLC

Provider Business Mailing Address
First Line	:	4901 RALEIGH COMMON DR
Second Line	:	SUITE 200
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 RALEIGH COMMON DR
Second Line	:	SUITE 200
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2478
Country	:	US
Telephone Number	:	901-387-2900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WHITNEY SLADE
Credential	:	MD
Telephone Number	:	901-387-2900

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	12/23/2009

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