Provider Demographics
NPI:1891069563
Name:COLLIERVILLE FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:COLLIERVILLE FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:901-221-8983
Mailing Address - Street 1:2028 W POPLAR AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0618
Mailing Address - Country:US
Mailing Address - Phone:901-221-8983
Mailing Address - Fax:901-221-8985
Practice Address - Street 1:2028 W POPLAR AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-221-8983
Practice Address - Fax:901-221-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty