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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