Provider Demographics
NPI:1679579072
Name:NEBLETT, PAUL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:NEBLETT
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 1:6215 HUMPHREYS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-747-1200
Mailing Address - Fax:901-747-1220
Practice Address - Street 1:80 HUMPHREYS CNTR DR
Practice Address - Street 2:STE 330
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2330
Practice Address - Country:US
Practice Address - Phone:901-747-1200
Practice Address - Fax:901-747-1220
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG85208Medicare UPIN
TN3884000Medicare ID - Type UnspecifiedTN PROVIDER NUMBER