# MID-SOUTH RETINA ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235329145
- **Authorized official:** RICHARD ERVIN SIEVERS M.D. (PRESIDENT)
- **Authorized official phone:** (901) 682-1100

## Contact information

- **Practice address:** 1804 E SHILOH RD, CORINTH, MS 38834-3637
- **Practice address phone:** (731) 427-7799
- **Practice address fax:** (731) 427-1476
- **Mailing address:** 6005 PARK AVE, SUITE 624B, MEMPHIS, TN 38119-5202
- **Mailing address phone:** (901) 682-1100
- **Mailing address fax:** (901) 682-6915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 18267 | MS | Yes |

## Other

- **Enumeration date:** 07/26/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04635763 | — | MS |