Provider Demographics
NPI:1467799767
Name:GERMANTOWN PRIVATE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:GERMANTOWN PRIVATE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-730-0575
Mailing Address - Street 1:7505 CAPITAL DR
Mailing Address - Street 2:THE CORPORATE CENTER
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3848
Mailing Address - Country:US
Mailing Address - Phone:901-730-0575
Mailing Address - Fax:901-730-0389
Practice Address - Street 1:7505 CAPITAL DR
Practice Address - Street 2:THE CORPORATE CENTER
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3848
Practice Address - Country:US
Practice Address - Phone:901-730-0575
Practice Address - Fax:901-730-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000453932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty