Provider Demographics
NPI:1508848672
Name:GIVENS, PRESTON G (MD)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:G
Last Name:GIVENS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9047 POPLAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6401
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-752-2367
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1906820OtherUNITED HEALTHCARE
TN7153011OtherAETNA
TN3918851OtherCIGNA
TN3918851OtherCIGNA