Provider Demographics
NPI:1720011679
Name:MID-SOUTH DERMATOLOGY, PC
Entity Type:Organization
Organization Name:MID-SOUTH DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-372-4545
Mailing Address - Street 1:6644 SUMMER KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2875
Mailing Address - Country:US
Mailing Address - Phone:901-372-4545
Mailing Address - Fax:901-372-4310
Practice Address - Street 1:6644 SUMMER KNOLL CIR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2875
Practice Address - Country:US
Practice Address - Phone:901-372-4545
Practice Address - Fax:901-372-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3382859Medicare ID - Type Unspecified