Provider Demographics
NPI:1457344145
Name:FAMILY PHYSICIANS GROUP PC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS GROUP PC
Other - Org Name:THE FAMILY PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-751-5536
Mailing Address - Street 1:2859 VAN LEER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4935
Mailing Address - Country:US
Mailing Address - Phone:901-752-6963
Mailing Address - Fax:901-751-5541
Practice Address - Street 1:2859 VAN LEER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4935
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-751-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3950820001Medicare NSC
TNCA4816Medicare PIN
TN3375194Medicare PIN