1184675332 NPI number — TODD MOTLEY M.D.

Table of content: TODD MOTLEY M.D. (NPI 1184675332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184675332 NPI number — TODD MOTLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTLEY
Provider First Name:
TODD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184675332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2153
Provider Second Line Business Mailing Address:
DEPT 3252
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35287-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-332-2277
Provider Business Mailing Address Fax Number:
901-332-2270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1264 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-332-2277
Provider Business Practice Location Address Fax Number:
901-332-2270
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD0000033846 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3857410 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09015714 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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