Provider Demographics
NPI:1922053941
Name:MEMPHIS PRIMARY CARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MEMPHIS PRIMARY CARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-276-2410
Mailing Address - Street 1:PO BOX 1000, DEPT. 265
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-276-2410
Mailing Address - Fax:901-261-6010
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:901-276-2410
Practice Address - Fax:901-261-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3382767Medicare ID - Type UnspecifiedMEDICARE GROUP