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Organization
MID-SOUTH RETINA ASSOCIATES, LLC
Active
Organization
MID-SOUTH RETINA ASSOCIATES, LLC
Active
Parent organization
MID-SOUTH RETINA ASSOCIATES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Authorized official
BRIAN BRADBERRY (PRACTICE ADMINISTRATOR)
(731) 427-7799
Entity
Organization
Contact information
Practice address
6760 GOODMAN RD STE 125, OLIVE BRANCH, MS 38654-7056
(901) 682-1100
(731) 265-2913
Mailing address
PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0001
(901) 682-1100
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
09/13/2022
Last updated
10/19/2022
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