Organization
THE FAMILY PHYSICIAN GROUP PC
Active
Organization
THE FAMILY PHYSICIAN GROUP PC
Active
Other names
HERMAN WESLEY DYKES JR DO
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE QUALLS (ADMINISTRATOR)
(901) 751-5514
Entity
Organization
Contact information
Practice address
7685 WINCHESTER RD STE 101, MEMPHIS, TN 38125-2202
(901) 260-9300
(901) 751-5541
Mailing address
2859 VAN LEER DR, MEMPHIS, TN 38133-4935
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
3926223
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4439154
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/14/2006
Last updated
11/19/2007
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