Basic Information
| Provider Information | |||||||||
| NPI: | 1376010850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-SOUTH GERIATRICS & PALLIATIVE CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7826 RADFORD RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381388233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016063205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6027 WALNUT GROVE RD STE 317 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018183921 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAHAL | ||||||||
| AuthorizedOfficialFirstName: | NIDAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9016063205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.