MEDICARE: RALEIGH CORDOVA MEDICAL GROUP, P.C.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1821198813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH CORDOVA MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	3809 COVINGTON PIKE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38135-2209
Country	:	US
Telephone Number	:	901-386-1625
Fax Number	:	901-377-8986

Provider Business Practice Location Address
First Line	:	3809 COVINGTON PIKE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38135-2209
Country	:	US
Telephone Number	:	901-386-1625
Fax Number	:	901-377-8986

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES SIKES
Credential	:	M.D.
Telephone Number	:	901-386-1625

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	09/04/2008

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