Provider Demographics
NPI:1639120876
Name:MOTLEY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MOTLEY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-332-2277
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 3252
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-0002
Mailing Address - Country:US
Mailing Address - Phone:901-332-2277
Mailing Address - Fax:901-332-2270
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-332-2277
Practice Address - Fax:901-332-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000033846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721502Medicaid
MS09015714Medicaid
TNH18733Medicare UPIN
TN3721502Medicare ID - Type Unspecified
TNH25120Medicare UPIN