Organization
PEDIATRIC RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA MALADY (BILLING)
(901) 737-3071
Entity
Organization
Contact information
Practice address
806 ESTATE PL, MEMPHIS, TN 38148-0001
(901) 737-3071
Mailing address
806 ESTATE PL, MEMPHIS, TN 38148-0001
(901) 737-3071
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
MD6355
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000746
—
TN
Enumeration date
04/03/2007
Last updated
08/22/2020
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