Provider Demographics
NPI:1467401323
Name:ADULT PRIMARY CARE OF MEMPHIS, PC
Entity Type:Organization
Organization Name:ADULT PRIMARY CARE OF MEMPHIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABUTINEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-324-3660
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0338
Mailing Address - Country:US
Mailing Address - Phone:901-324-3660
Mailing Address - Fax:901-324-3668
Practice Address - Street 1:3294 POPLAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4649
Practice Address - Country:US
Practice Address - Phone:901-324-3660
Practice Address - Fax:901-324-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812969Medicaid
TN3812969Medicaid
TN3812969Medicare ID - Type Unspecified