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NPI Code Detail

MEDICARE: SHELBY COUNTY PHYSICIANS, PLLC

MEDICARE: SHELBY COUNTY PHYSICIANS, PLLC
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician
2208100000XPhysical Medicine & Rehabilitation Physician
3207QG0300XGeriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1871051474
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELBY COUNTY PHYSICIANS, PLLC
Provider Business Mailing Address
First Line : 5665 NEW NORTHSIDE DR STE 320
Second Line :
City : ATLANTA
State : GA
Zip : 30328-5834
Country : US
Telephone Number : 770-874-5400
Fax Number :
Provider Business Practice Location Address
First Line : 6500 KIRBY GATE BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-2673
Country : US
Telephone Number : 901-752-0772
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : MRS. LISA ROSE HALE
Credential :
Telephone Number : 770-874-5439
Provider Enumeration Date : 03/04/2019
Last Update Date : 03/04/2019

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