Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 48992 | TN |
Y | 2080P0208X | Pediatric Infectious Diseases | 48992 | TN |
NPI | 1568780153 |
---|---|
Provider Name | Dr. Nicholas Daniel Hysmith |
First Address | Memphis, MS 38654 |
Second Address | Memphis, TN 38103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 08/06/2016 |