| NPI | 1255602587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABATHA PERRY Manager, Provider Enrollment 901-478-0954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 2080P0202X Pediatrics, Pediatric Cardiology | |
| 207VG0400X Obstetrics & Gynecology, Gynecology | |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2025-09-22 |