Provider Demographics
NPI:1255393013
Name:SACKS, HAROLD S (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:S
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2145
Mailing Address - Country:US
Mailing Address - Phone:901-681-0346
Mailing Address - Fax:901-682-7737
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-681-0346
Practice Address - Fax:901-682-7737
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10734207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164747Medicaid
TN460001891OtherRAILROAD MEDICARE
TN460001891OtherRAILROAD MEDICARE
3164749Medicare ID - Type Unspecified