| Jim Pang Md Pllc | |
|
65 Germantown Ct Ste 402 Cordova TN 38018 | |
| (901) 752-4900 | |
| (901) 752-4902 |
| Full Name | Jim Pang Md Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 65 Germantown Ct Ste 402, Cordova, Tennessee |
| Authorized Official Name and Position | Jennifer Hamilton (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 9017524900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jim Pang Md Pllc 65 Germantown Ct Ste 402 Cordova TN 38018-4275 Ph: (901) 752-4900 | Jim Pang Md Pllc 65 Germantown Ct Ste 402 Cordova TN 38018 Ph: (901) 752-4900 |
| NPI Number | 1447620901 |
|---|---|
| Provider Enumeration Date | 09/28/2015 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Medicare PECOS PAC ID | 4688925696 |
|---|---|
| Medicare Enrollment ID | O20181001001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447620901 | NPI | - | NPPES |
| Q035474 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | 017659 (Tennessee) | Primary |
| Provider Name | Jim Pang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780690230 PECOS PAC ID: 2769459338 Enrollment ID: I20040913001404 |
| Provider Name | Javina Driver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295043693 PECOS PAC ID: 0941483929 Enrollment ID: I20110329000577 |
| Provider Name | Angie D Hicks-master |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255405353 PECOS PAC ID: 5496858110 Enrollment ID: I20130826000960 |
| Provider Name | Amanda Nicola Jackson Woodall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073092185 PECOS PAC ID: 4789929076 Enrollment ID: I20190108003765 |
| Provider Name | Ariel Michelle Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700534310 PECOS PAC ID: 0042698920 Enrollment ID: I20220606000911 |
| Provider Name | Schyler Blake Webber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184406142 PECOS PAC ID: 8921455775 Enrollment ID: I20231115003316 |
| Provider Name | Melanie Anon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427743657 PECOS PAC ID: 4082058854 Enrollment ID: I20240220003060 |
| Provider Name | Karen Roy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295500866 PECOS PAC ID: 1759726292 Enrollment ID: I20240223003366 |
| Provider Name | Tristan Mckenzie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922678309 PECOS PAC ID: 2163942210 Enrollment ID: I20250220000923 |
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