Provider Demographics
NPI:1376010850
Name:MID-SOUTH GERIATRICS & PALLIATIVE CARE PLLC
Entity Type:Organization
Organization Name:MID-SOUTH GERIATRICS & PALLIATIVE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-606-3205
Mailing Address - Street 1:7826 RADFORD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-8233
Mailing Address - Country:US
Mailing Address - Phone:901-606-3205
Mailing Address - Fax:
Practice Address - Street 1:6027 WALNUT GROVE RD STE 317
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-818-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care