Organization
COLLIERVILLE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYA VENKATARAMAN MD (MD/PRESIDENT)
(901) 854-5455
Entity
Organization
Contact information
Practice address
2028 W POPLAR AVE, SUITE 112, COLLIERVILLE, TN 38017-0618
(901) 854-5455
(901) 377-7309
Mailing address
2028 W POPLAR AVE, SUITE 112, COLLIERVILLE, TN 38017-0618
(901) 854-5455
(901) 377-7309
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38751
TN
Other
Enumeration date
11/19/2007
Last updated
11/19/2007
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