Provider Demographics
NPI:1598395501
Name:CALDWELL, RAYMOND BENNETT IV (PA-C)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:BENNETT
Last Name:CALDWELL
Suffix:IV
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5701 BAIRD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7103
Mailing Address - Country:US
Mailing Address - Phone:901-494-4992
Mailing Address - Fax:
Practice Address - Street 1:7601 SOUTHCREST PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4739
Practice Address - Country:US
Practice Address - Phone:662-772-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant