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Organization
TENNESSEE PHS MD LLC
Active
Organization
TENNESSEE PHS MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOWARD (CEO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
9155 CRESTWYN HILLS DR, MEMPHIS, TN 38125-8501
(337) 991-9276
Mailing address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
NULL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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