Organization
PRIMARY CARE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN JENSEN (OFFICE MANAGER)
(901) 567-3414
Entity
Organization
Contact information
Practice address
3109 WALNUT GROVE ROAD, MEMPHIS, TN 38111-3509
(901) 515-4842
(901) 458-0405
Mailing address
PO BOX 1726, MEMPHIS, TN 38101-1726
(901) 515-4842
(901) 458-0405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0966550001
DMEM
TN
05
—
3703214
—
TN
Enumeration date
11/06/2006
Last updated
01/12/2021
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