Provider Demographics
NPI:1508848672
Name:GIVENS, PRESTON G (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:G
Last Name:GIVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-0881
Mailing Address - Fax:901-516-0528
Practice Address - Street 1:8035 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5977
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-758-6060
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD29837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1906820OtherUNITED HEALTHCARE
TN7153011OtherAETNA
TN3918851OtherCIGNA
TN3918851OtherCIGNA