Provider Demographics
NPI:1265433213
Name:FAHHOUM, JOSEPH S (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:FAHHOUM
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 1:823 ROCKY HILLS CV S
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6540
Mailing Address - Country:US
Mailing Address - Phone:901-202-4100
Mailing Address - Fax:901-202-4102
Practice Address - Street 1:2034 EXETER RD STE 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3950
Practice Address - Country:US
Practice Address - Phone:901-202-4100
Practice Address - Fax:901-202-4100
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24839207P00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3893890Medicare ID - Type Unspecified
TNF63238Medicare UPIN