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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
920 MADISON AVE SUITE 447, MEMPHIS, TN 38163-2251
(901) 448-2884
(901) 448-1684
Mailing address
920 MADISON AVE FL 2, MEMPHIS, TN 38163-2251
(901) 448-1684

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
07/29/2024
Last updated
05/30/2025
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