MEDICARE: JAMES PICKENS

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	40314	TN

General Provider Information

NPI Number	:	1922969831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PICKENS

Provider Business Mailing Address
First Line	:	5669 WALNUT GROVE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2029
Country	:	US
Telephone Number	:	901-356-4680
Fax Number	:

Provider Business Practice Location Address
First Line	:	5669 WALNUT GROVE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2029
Country	:	US
Telephone Number	:	901-356-4680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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