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Organization

PRIMARY CARE GROUP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TABATHA PERRY (MANAGER, PROVIDER ENROLLMENT)
(901) 478-0954
Entity
Organization

Contact information

Practice address
1211 UNION AVE STE 200, MEMPHIS, TN 38104-6654
(901) 525-0278
Mailing address
1211 UNION AVE STE 700, MEMPHIS, TN 38104-6600
(901) 478-0954
(901) 937-6696

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207RG0100X
Gastroenterology Physician
207RR0500X
Rheumatology Physician
207V00000X
Obstetrics & Gynecology Physician
208000000X
Pediatrics Physician
2084N0400X
Neurology Physician
363A00000X
Physician Assistant
363LA2200X
Adult Health Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1522556
TN
01
4290151
BCBS TN
TN
01
DR2914
RAILROAD MEDICARE
TN
01
DS1812
RAILROAD MEDICARE
MS
Enumeration date
11/12/2010
Last updated
09/22/2025
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