Organization
PEDIATRIC CARDIOLOGY CONSULTANTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAGGIE A BONICELLI (OFFICE MANAGER)
(901) 682-7774
Entity
Organization
Contact information
Practice address
6401 POPLAR AVE, STE 402, MEMPHIS, TN 38119-4823
(901) 682-7774
(901) 682-6963
Mailing address
PO BOX 1236, PARIS, TN 38242-1236
(901) 682-7774
(901) 682-6963
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21716
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014475
—
MS
Enumeration date
12/20/2007
Last updated
12/20/2007
Update your record
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