Organization
MID SOUTH VASCULAR CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE T DAVIS MD (OWNER)
(901) 683-4471
Entity
Organization
Contact information
Practice address
6027 WALNUT GROVE RD, SUITE 205, MEMPHIS, TN 38120-2145
(901) 683-4471
(901) 683-3915
Mailing address
6027 WALNUT GROVE RD, SUITE 205, MEMPHIS, TN 38120-2145
(901) 683-4471
(901) 683-3915
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
06816
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3149502
—
TN
Enumeration date
07/22/2006
Last updated
07/08/2008
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