Provider Demographics
NPI:1275996845
Name:PEEDEN, ERIN H
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:H
Last Name:PEEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-842-3160
Mailing Address - Fax:
Practice Address - Street 1:3362 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-2944
Practice Address - Country:US
Practice Address - Phone:901-842-3166
Practice Address - Fax:901-842-2366
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61065207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics