Provider Demographics
NPI:1649207242
Name:ARNOLD, ANITA L (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1068 CRESTHAVEN RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0800
Mailing Address - Country:US
Mailing Address - Phone:901-685-3490
Mailing Address - Fax:901-685-3499
Practice Address - Street 1:1068 CRESTHAVEN RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0800
Practice Address - Country:US
Practice Address - Phone:901-685-3490
Practice Address - Fax:901-685-3499
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN26308207R00000X
MS14748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01128611OtherRAILROAD MEDICARE
MS09307880Medicaid
TN380409Medicaid
AR140902001Medicaid
G24287Medicare UPIN
AR140902001Medicaid
TN3879774Medicare PIN
TN5196182OtherAETNA
MS109882405HOtherMS BCBS
MO209274307Medicaid
TN3879773Medicaid
MS110001740Medicare PIN