Pediatric Psychiatric Professional LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

PEDIATRIC PSYCHIATRIC PROFESSIONAL LLC

Practice address

1661 International Dr Ste 400
Memphis, TN 38120-1431

Phone

(713) 628-8199

Fax

(901) 425-9726

NPI assigned

Oct 30, 2024

Last updated

Oct 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charles Randale Frith, LCSWNPI 1386083384

Title

Operations Manager

Phone

(318) 527-9322

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 2

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.

• Nga T. Huynh, MD

  • Psychiatry Physician
  • Memphis, TN
  • NPI 1679716013

  Child & Adolescent Psychiatry

  Medicare reassignment NPD
• Charles Randale Frith, L.C.S.W.

  • Clinical Social Worker
  • Columbia, LA
  • NPI 1386083384
  NPD Authorized official

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1811719834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17452",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381870452",
            "telephone_number": "318-527-9322",
            "fax_number": "901-425-9726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 INTERNATIONAL DR STE 400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381201431",
            "telephone_number": "713-628-8199",
            "fax_number": "901-425-9726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHIATRIC PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "FRITH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "RANDALE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "318-527-9322",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Child & Adolescent Psychiatry Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.