| Graceland Internal Medicine | |
|
1264 Wesley Dr Suite 405 Memphis TN 38116-6400 | |
| (901) 396-3061 | |
| (901) 396-7841 |
| Full Name | Graceland Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1264 Wesley Dr, Memphis, Tennessee |
| Authorized Official Name and Position | Theresa F Edmiston (ADMINISTRATOR) |
| Authorized Official Contact | 9013406777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceland Internal Medicine 1264 Wesley Dr Suite 405 Memphis TN 38116-6400 Ph: (901) 396-3061 | Graceland Internal Medicine 1264 Wesley Dr Suite 405 Memphis TN 38116-6400 Ph: (901) 396-3061 |
| NPI Number | 1851317333 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851317333 | NPI | - | NPPES |
| 3372151 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD010326 (Tennessee) | Primary |
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