Organization Active NPI

Pediatric Radiology

  • Pediatric Radiology Physician
  • Memphis, TN
National Provider Identifier
1225159643
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Radiology PhysicianTaxonomy code 2085P0229X
License
MD6355 Issued in TN
Legal business name
PEDIATRIC RADIOLOGY
Practice address
806 Estate PL
Memphis, TN 38148-0001
Phone
(901) 737-3071
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tonya Malady
Title
Billing
Phone
(901) 737-3071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085P0229X MD6355 TN Primary

Addresses

Primary practice location

806 Estate PL
Memphis, TN 38148-0001

Mailing address

806 Estate PL
Memphis, TN 38148-0001
Phone (901) 737-3071

Other identifiers 1

IdentifierTypeStateIssuer
3000746MedicaidTN

National Provider Directory

National Provider Directory

Locations

806 Estate Pl
Memphis, TN 38120
Phone (901) 572-3031

6141 Walnut Grove Rd
Ste 200
Memphis, TN 38120
Phone (901) 747-4121

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225159643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 ESTATE PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "901-737-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 ESTATE PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "901-737-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC RADIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALADY",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "901-737-3071"
    },
    "taxonomies": [
        {
            "code": "2085P0229X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Pediatric Radiology",
            "state": "TN",
            "license": "MD6355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3000746",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.