Provider Demographics
NPI:1609096148
Name:EARNEST, CHRISTI LEE CAZALAS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LEE CAZALAS
Last Name:EARNEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:LEE
Other - Last Name:CAZALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3473 POPLAR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4654
Practice Address - Country:US
Practice Address - Phone:901-320-6915
Practice Address - Fax:301-320-6920
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30158207R00000X, 208000000X
TN47922208000000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525696Medicaid
TN1525696Medicaid