Basic Information
| Provider Information | |||||||||
| NPI: | 1649207242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1068 CRESTHAVEN RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016853490 | ||||||||
| FaxNumber: | 9016853499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1068 CRESTHAVEN RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016853490 | ||||||||
| FaxNumber: | 9016853499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26308 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 14748 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01128611 | 01 | TN | RAILROAD MEDICARE | OTHER | 09307880 | 05 | MS | MEDICAID | 380409 | 05 | TN | MEDICAID | 140902001 | 05 | AR | MEDICAID |