Provider Demographics
NPI:1760476824
Name:PORTER, JOLIE GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:GARCIA
Last Name:PORTER
Suffix:
Gender:F
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:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-756-1231
Mailing Address - Fax:901-755-1590
Practice Address - Street 1:7690 WOLF RIVER CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1744
Practice Address - Country:US
Practice Address - Phone:901-756-1231
Practice Address - Fax:901-756-1195
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522479Medicaid
TN4342199OtherBCBS
P01213528OtherRAILROAD MEDICARE
P01213528OtherRAILROAD MEDICARE
F79632Medicare UPIN