Provider Demographics
NPI:1497083703
Name:RHEUMATOLOGY & DERMATOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RHEUMATOLOGY & DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-683-2874
Mailing Address - Street 1:5210 POPLAR AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3515
Mailing Address - Country:US
Mailing Address - Phone:901-683-2874
Mailing Address - Fax:901-683-3617
Practice Address - Street 1:8143 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7270
Practice Address - Country:US
Practice Address - Phone:901-759-3073
Practice Address - Fax:901-754-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018701174400000X
TNMD0000024040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051299Medicare PIN
TN3073678Medicare PIN