Individual
MACK A LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
880 MADISON AVE, MEMPHIS, TN 38103-3409
(901) 545-6969
(901) 545-7177
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-8336
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD8514
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010933
—
MS
01
—
23973
BCBS OF TN
TN
05
—
3199828
—
TN
Enumeration date
07/10/2006
Last updated
02/11/2015
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