DR. GREGORY L STIDHAM (NPI# 1366409666) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366409666 |
| Entity Type | Individual |
| Full Name | DR. GREGORY L STIDHAM |
| Credential | MD |
| Practice Address |
1910 Nonconnah Blvd Suite 120 Memphis TN 38132-2113 |
| Mailing Address |
66 N Pauline St Suite 206 Memphis TN 38105-5105 |
| Practice Telephone | 9014482300 |
| Practice Fax Number | 9014486657 |
| Mailing Telephone | 9014487642 |
| Mailing Fax Number | 9014488015 |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
12680 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3180615 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487627378 | Gregory Stidham | Family Medicine | 1107a Brookdale St, Martinsville, VA 24112-4501 | 2006-02-10 |
| 1831183219 | Gregory P Stidham | Family Medicine | 110 23rd St Nw, Fayette, AL 35555-1001 | 2005-08-31 |
| Street Address |
1910 NONCONNAH BLVD SUITE 120 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38132-2113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417933276 | Cynthia Denise Cross | Emergency Medicine | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2005-12-22 |
| 1265719496 | Tamara Devon Jones | Social Worker | 1910 Nonconnah Blvd, Suite #100, Memphis, TN 38132-2113 | 2011-11-16 |
| 1417244765 | Compass Laboratory Services LLC | Clinical Medical Laboratory | 1910 Nonconnah Blvd, 108, Memphis, TN 38132-2113 | 2011-07-07 |
| 1508090986 | Oana Maria Hendea | Audiologist | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2009-05-13 |
| 1649429119 | Dawna J. Willis | Nurse Practitioner | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2008-09-09 |
| 1538315304 | Samir Hasmukh Shah | Pediatrics | 1910 Nonconnah Blvd, Ste 120, Memphis, TN 38132-2113 | 2008-08-13 |
| 1710163373 | Martha Katheryn Ballard | Nurse Practitioner | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2008-01-14 |
| 1861673816 | Keith A. Collins | Nurse Anesthetist, Certified Registered | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2007-11-19 |
| 1851510978 | Mindy A Mullins | Nurse Anesthetist, Certified Registered | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2007-04-25 |
| 1275629396 | Sabrina Burns Kuster | Pediatrics | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2006-10-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386163707 | Casey Provo | Dietitian, Registered | 1689 Nonconnah Blvd., Memphis, TN 38132 | 2017-09-18 |
| 1164802195 | Cynthia Luaune Poole | Social Worker | 2606 Corporate Dr, Memphis, TN 38132 | 2015-06-04 |
| 1033375753 | Concentra Health Services, Inc. | Clinic/Center | 2831 Airways Blvd., Bldg. A, Suite 102, Memphis, TN 38132 | 2008-08-01 |
| 1063406676 | The Synergy Foundation, Inc. | Substance Abuse Rehabilitation Facility | 2305 Airport Interchange Avenue, Memphis, TN 38132 | 2005-09-09 |
| 1932488129 | Occupational Health Centers of The Southwest Pa | Clinic/Center | 2831 Airways Blvd, Bldg A, Ste 102, Memphis, TN 38132 | 2011-08-05 |
| 1699181461 | Stacy Triplett | Counselor | 2305 Airport Interchange Ave, Memphis, TN 38132-1002 | 2014-07-01 |
| 1174852164 | Delois Roberson | Dentist | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2009-12-22 |
| 1801380985 | Javier Jackson | Physical Therapist | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2018-06-21 |
| 1326499252 | Joshua Mock | Physical Therapy Assistant | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2016-06-22 |
| 1295112720 | Michelle Frulla | Physical Therapy Assistant | 2781 Airways Blvd, Memphis, TN 38132-1104 | 2015-05-05 |
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| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295266906 | Ashlee Christmas | Pediatrics | 920 Madison Avenue Suite 447, Memphis, TN 38163-3818 | 2017-03-23 |
| 1477893121 | Maria Del Pilar Anton Martin | Pediatrics | 51 N Dunlap St Fl 2, Memphis, TN 38105 | 2013-02-17 |
| 1053670273 | Shantaveer Gangu | Pediatrics | 848 Adams Ave, Memphis, TN 38103-2816 | 2012-05-08 |
| 1568729747 | Laurel Jeanette Metzler | Pediatrics | 848 Adams Ave, Memphis, TN 38103-2816 | 2012-04-12 |
| 1689930653 | Sheridan Children's Healthcare Services of Tennessee, PC | Pediatrics | 6225 Humphreys Blvd, Memphis, TN 38120-2373 | 2012-04-04 |
| 1629367909 | Nicholas Paul Morin | Pediatrics | 848 Adams Ave, Memphis, TN 38103 | 2011-04-07 |
| 1639494040 | Asya Agulnik | Pediatrics | 262 Danny Thomas Pl, Memphis, TN 38105-3678 | 2010-03-30 |
| 1538315304 | Samir Hasmukh Shah | Pediatrics | 1910 Nonconnah Blvd, Ste 120, Memphis, TN 38132-2113 | 2008-08-13 |
| 1265651830 | Saad Ghafoor | Pediatrics | 262 Danny Thomas Pl, Memphis, TN 38105-3678 | 2007-04-24 |
| 1871673202 | Nadeem I Shafi | Pediatrics | 848 Adams Ave, Memphis, TN 38103-2816 | 2006-10-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.