NPI 1104640564 · live from the CMS NPI Registry
A1 Family Physicians
Family Medicine in Memphis, TN. National Provider Identifier 1104640564, active.
NPI record
| NPI | 1104640564 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 890 Garland St, Memphis, TN 38107 |
| Practice phone | 901-673-3111 |
| Enumerated | November 12, 2024 |
| Last updated | January 16, 2025 |
| Authorized official | Andrea Ivory Fuller, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist | 103T00000X | — |
| Dietitian, Registered | 133V00000X | — |
| Health & Wellness Coach | 171400000X | — |
| Family Medicine primary | 207Q00000X | — |
| Internal Medicine, Nephrology | 207RN0300X | — |
| Pediatrics | 208000000X | — |
| Physician Assistant | 363A00000X | — |
| Nurse Practitioner, Family | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.