Basic Information
| Provider Information | |||||||||
| NPI: | 1164488573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEDZI | ||||||||
| FirstName: | LUCIEN | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1457 GOODBAR AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381044912 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6019 WALNUT GROVE RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012260340 | ||||||||
| FaxNumber: | 9012260349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD13721R | LA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | G68759 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 28335 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | N0308 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.