# MID-SOUTH RETINA ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MID-SOUTH RETINA ASSOCIATES, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639891088
- **Legal business name:** MID-SOUTH RETINA ASSOCIATES, LLC
- **Authorized official:** BRIAN BRADBERRY (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (731) 427-7799

## Contact information

- **Practice address:** 6760 GOODMAN RD STE 125, OLIVE BRANCH, MS 38654-7056
- **Practice address phone:** (901) 682-1100
- **Practice address fax:** (731) 265-2913
- **Mailing address:** PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0001
- **Mailing address phone:** (901) 682-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/13/2022
- **Last updated:** 10/19/2022