NPIMap

Organization Active NPI

Memphis Nutrition Group, LLC

  • Clinic/Center
  • Memphis, TN
National Provider Identifier
1538799515
Registry record updated Jan 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MEMPHIS NUTRITION GROUP, LLC
Practice address
6263 Poplar Ave Ste 605
Memphis, TN 38119-4724
Phone
(901) 343-6146
Fax
(901) 328-1802
NPI assigned
Jan 18, 2020
Last updated
Jan 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2020

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

Authorized official

Name
Blair Mize, MS, RDN, CSSD, LDNNPI 1174153159
Title
Co-Owner
Phone
(901) 619-1942

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

6263 Poplar Ave Ste 605
Memphis, TN 38119-4724

Mailing address

6263 Poplar Ave Ste 605
Memphis, TN 38119-4724
Phone (901) 343-6146

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL 901-328-1802

National Provider Directory

National Provider Directory

Locations

6263 Poplar Ave
Ste 605
Memphis, TN 38119
Phone (901) 343-6146

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1579305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579305600000",
    "number": "1538799515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6263 POPLAR AVE STE 605",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194724",
            "telephone_number": "901-343-6146",
            "fax_number": "901-328-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6263 POPLAR AVE STE 605",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194724",
            "telephone_number": "901-343-6146",
            "fax_number": "901-328-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS NUTRITION GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-18",
        "last_updated": "2020-01-18",
        "certification_date": "2020-01-18",
        "status": "A",
        "authorized_official_last_name": "MIZE",
        "authorized_official_first_name": "BLAIR",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "901-619-1942",
        "authorized_official_credential": "MS, RDN, CSSD, LDN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "901-328-1802",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "address_1": "6263 Poplar Ave Ste 605",
            "city": "Memphis",
            "state": "TN",
            "country_code": "US",
            "postal_code": "381194724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Jan 18, 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.