Provider Demographics
NPI:1497820146
Name:MEMON, FAIZA B (MD)
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:B
Last Name:MEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 VIRGINIA WAY STE C11
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7557
Mailing Address - Country:US
Mailing Address - Phone:615-373-5205
Mailing Address - Fax:615-373-5160
Practice Address - Street 1:5123 VIRGINIA WAY STE C11
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7557
Practice Address - Country:US
Practice Address - Phone:615-373-5205
Practice Address - Fax:615-373-5160
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000391212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111508OtherBLUE CROSS BLUE SHEILD
TN4111508OtherBLUE CROSS BLUE SHEILD
TN3332111Medicare ID - Type Unspecified