Provider Demographics
NPI:1588664726
Name:PRESBURY, GERALD JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JOHNSON
Last Name:PRESBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WASHINGTON AVE
Mailing Address - Street 2:SUITE P 110
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4550
Mailing Address - Country:US
Mailing Address - Phone:901-448-2000
Mailing Address - Fax:901-287-6072
Practice Address - Street 1:50 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2800
Practice Address - Country:US
Practice Address - Phone:901-869-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13054207PP0204X
TNMD 13054208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3187118Medicaid
AP1019442OtherDEA
TNB59477Medicare UPIN
AP1019442OtherDEA