Organization
GERIATRIC AND HOSPICE ASSOCIATES OF THE MID SOUTH PLLC
Active
Organization
GERIATRIC AND HOSPICE ASSOCIATES OF THE MID SOUTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY VILLANUEVA MD (PRESIDENT)
(901) 818-3921
Entity
Organization
Contact information
Practice address
6025 WALNUT GROVE RD STE 317, MEMPHIS, TN 38120-2131
(901) 818-3921
(901) 767-3056
Mailing address
6799 GREAT OAKS RD STE 250, MEMPHIS, TN 38138-2584
(901) 261-0700
(901) 261-0701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
11/07/2019
Last updated
11/15/2019
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