Organization
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC
Active
Parent organization
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC
Authorized official
WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
(615) 372-3375
Entity
Organization
Contact information
Practice address
1409 KINGSLEY AVE STE 6A, ORANGE PARK, FL 32073-4592
(904) 639-2270
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 372-5426
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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