Diversified Healthcare

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

39250 Issued in TN

Legal business name

DIVERSIFIED HEALTHCARE

Practice address

6005 Park Ave
Suite 704
Memphis, TN 38119-5202

Phone

(901) 684-4646

Fax

(901) 684-4650

NPI assigned

Sep 20, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Shrearest Mignon Crenshaw, MD

Title

Physician

Phone

(901) 684-4646

Specialties & licenses 1

Addresses

Practitioners 1

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

• Shrearest Crenshaw Johnson, M.D.

  • Family Medicine Physician
  • Miramar, FL
  • NPI 1619976735
  NPD (past)

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1457634180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "SUITE 704",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195202",
            "telephone_number": "901-684-4646",
            "fax_number": "901-684-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "SUITE 704",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195202",
            "telephone_number": "901-684-4646",
            "fax_number": "901-684-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "CRENSHAW",
        "authorized_official_first_name": "SHREAREST",
        "authorized_official_middle_name": "MIGNON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "901-684-4646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "39250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwight Anthony Dishmon, MD
• Christopher James Distin
• Amy Distretti, NNP
• Mary Grace Distretti, DPT
• Lauren C Ditta, M.D.
• Divine Caring Home Health Inc
• Divine Intervention Home Care Agency LLC
• Divine Intervention Transportation Services PLLC
• Divine Trinity Outreach Center
• Division of Clinical Neurosciences, LLC

• Primary Care Clinic/Center in Memphis, TN
• Providers in Memphis, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.