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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