Organization
MEMPHIS & SHELBY COUNTY PEDIATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE CARTER (BILLING SUPERVISOR)
(901) 396-8366
Entity
Organization
Contact information
Practice address
6479 WINCHESTER RD, SUITE 118, MEMPHIS, TN 38115-4240
(901) 866-2133
(901) 866-2136
Mailing address
1444 E SHELBY DR, SUITE 317, MEMPHIS, TN 38116-7260
(901) 396-8281
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117847
UNISON
TN
01
—
5598466
AETNA
TN
Enumeration date
02/15/2007
Last updated
08/22/2020
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