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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