Provider Demographics
NPI:1073824561
Name:OVERHOLSER, EMILY T (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:T
Last Name:OVERHOLSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 VERA CRUZ ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7303
Mailing Address - Country:US
Mailing Address - Phone:407-619-5239
Mailing Address - Fax:
Practice Address - Street 1:1455 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6727
Practice Address - Country:US
Practice Address - Phone:901-726-6655
Practice Address - Fax:901-726-9056
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51433207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology