Provider Demographics
NPI:1033210604
Name:HICKORY HILL FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:HICKORY HILL FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GRAYER
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-794-5806
Mailing Address - Street 1:3530 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3827
Mailing Address - Country:US
Mailing Address - Phone:901-794-5806
Mailing Address - Fax:901-794-7922
Practice Address - Street 1:3530 HICKORY HILL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3827
Practice Address - Country:US
Practice Address - Phone:901-794-5806
Practice Address - Fax:901-794-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty