Provider Demographics
NPI:1396192746
Name:FONER MED, PLLC
Entity Type:Organization
Organization Name:FONER MED, PLLC
Other - Org Name:CARE MEMPHIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICIAN ASSISTANT - CERTIF
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FONER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:901-652-4250
Mailing Address - Street 1:215 BUNTYN ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1609
Mailing Address - Country:US
Mailing Address - Phone:901-652-4250
Mailing Address - Fax:
Practice Address - Street 1:493 DR ML KING JR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-2548
Practice Address - Country:US
Practice Address - Phone:901-526-0802
Practice Address - Fax:901-525-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2811261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care