| Customized Medical Needs | |
|
578 Harrell St Memphis TN 38112-2932 | |
| (901) 907-0640 | |
| (901) 255-0758 |
| Full Name | Customized Medical Needs |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 578 Harrell St, Memphis, Tennessee |
| Authorized Official Name and Position | Christi Alexander Davidson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8665637772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Customized Medical Needs 578 Harrell St Memphis TN 38112-2932 Ph: (901) 907-0640 | Customized Medical Needs 578 Harrell St Memphis TN 38112-2932 Ph: (901) 907-0640 |
| NPI Number | 1124361688 |
|---|---|
| Provider Enumeration Date | 04/03/2013 |
| Last Update Date | 09/29/2025 |
| Certification Date | 09/29/2025 |
| Medicare PECOS PAC ID | 8921249517 |
|---|---|
| Medicare Enrollment ID | O20130724000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124361688 | NPI | - | NPPES |
| 1531379 | Medicaid | TN | |
| 103G700897 | Other | TN | MEDICARE (PTAN) |
| Provider Name | Dwight Anthony Dishmon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316904048 PECOS PAC ID: 9931165941 Enrollment ID: I20041201001010 |
| Provider Name | Darl Vilbro Bell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275538977 PECOS PAC ID: 5294718474 Enrollment ID: I20051222000714 |
| Provider Name | Keevia Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770742066 PECOS PAC ID: 7517039399 Enrollment ID: I20080710000798 |
| Provider Name | Kendrick Joyce |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1801949847 PECOS PAC ID: 2466518956 Enrollment ID: I20090309000259 |
| Provider Name | Theresa Lynette Woodard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124045638 PECOS PAC ID: 6002814241 Enrollment ID: I20120131000410 |
| Provider Name | Brenita M Seay |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639707144 PECOS PAC ID: 7618419789 Enrollment ID: I20240604002358 |
| Provider Name | Darin Dantzler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215375316 PECOS PAC ID: 6103361282 Enrollment ID: I20240712002359 |
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