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NPI Code Detail

MEDICARE: DR. DOUGLAS J HART PH.D.

MEDICARE: DR. DOUGLAS J HART PH.D.
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
1103TB0200XCognitive & Behavioral PsychologistP0000001092TN
2103TA0700XAdult Development & Aging PsychologistP0000001092TN
3103TC0700XClinical PsychologistP0000001092TN
4103TC2200XClinical Child & Adolescent PsychologistP0000001092TN
5103TF0000XFamily PsychologistP0000001092TN
6103TM1800XIntellectual & Developmental Disabilities PsychologistP0000001092TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10044740OTHERTNTN BLUE CROSS BLUE SHIELD
259964OTHERTNCIGNA

General Provider Information

NPI Number : 1790785723
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS J HART PH.D.
Provider Business Mailing Address
First Line : 3950 CENTRAL AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Provider Business Practice Location Address
First Line : 3950 CENTRAL AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 02/04/2008

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