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Organization
POPLAR AVENUE CLINIC PLLC
Active
Organization
POPLAR AVENUE CLINIC PLLC
Active
Other names
Poplar Avenue Clinic PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
HUDA ALAEDDIN (OFFICE MANAGER)
(901) 870-8840
Entity
Organization
Contact information
Practice address
6584 POPLAR AVE STE 400, MEMPHIS, TN 38138-3687
(901) 300-6713
(901) 552-5891
Mailing address
PO BOX 172344, MEMPHIS, TN 38187-2344
(901) 870-8840
(901) 552-5891
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6528091
—
MS
05
—
893541
—
TN
Enumeration date
03/20/2019
Last updated
09/06/2022
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