Provider Demographics
NPI:1316961931
Name:METRO MEMPHIS MEDICAL SPECIALIST, INC.
Entity type:Organization
Organization Name:METRO MEMPHIS MEDICAL SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-366-3883
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:#420
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:901-366-3883
Mailing Address - Fax:901-366-3887
Practice Address - Street 1:3960 KNIGHT ARNOLD RD
Practice Address - Street 2:#420
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3035
Practice Address - Country:US
Practice Address - Phone:901-366-3883
Practice Address - Fax:901-366-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731970Medicaid
TN3731970Medicare ID - Type Unspecified