Basic Information
Provider Information | |||||||||
NPI: | 1184940405 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ABRAMS | ||||||||
FirstName: | WINFRED | ||||||||
MiddleName: | BERNARD | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381195754 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9012591600 | ||||||||
FaxNumber: | 9012591698 | ||||||||
Practice Location | |||||||||
Address1: | 6286 BRIARCREST AVE STE 200 | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381204023 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9012591600 | ||||||||
FaxNumber: | 9012591698 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2010 | ||||||||
LastUpdateDate: | 04/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PENDING | MS | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208100000X | 62209 | TN | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208100000X | 28229 | MS | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208VP0000X | 28229 | MS | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0000X | 62209 | TN | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 02102790 | 05 | MS |   | MEDICAID | Q061827 | 05 | TN |   | MEDICAID | 6248298 | 01 | TN | BCBS TN | OTHER | 1H1552 | 01 | MS | MS MEDICARE | OTHER | Q10858A | 01 | TN | TN MEDICARE | OTHER |