Provider Demographics
NPI:1316009137
Name:COATES, GLYNIS C (MD)
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:C
Last Name:COATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLYNIS
Other - Middle Name:C
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6075 POPLAR AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4740
Mailing Address - Country:US
Mailing Address - Phone:901-795-3600
Mailing Address - Fax:
Practice Address - Street 1:6075 POPLAR AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4740
Practice Address - Country:US
Practice Address - Phone:901-795-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002616363A00000X
MS24111207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant