Provider Demographics
NPI:1235350786
Name:PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-1880
Mailing Address - Street 1:1102 BROOKFIELD ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-761-1880
Mailing Address - Fax:901-683-2048
Practice Address - Street 1:1102 BROOKFIELD ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-761-1880
Practice Address - Fax:901-683-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty