Organization
MID-SOUTH MATERNAL FETAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC W GIBSON (CEO)
(901) 373-8949
Entity
Organization
Contact information
Practice address
6266 POPLAR AVE, MEMPHIS, TN 38119-4713
(901) 682-2595
(901) 682-2549
Mailing address
6266 POPLAR AVE, MEMPHIS, TN 38119-4713
(901) 682-2595
(901) 682-2549
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07470206
—
MS
05
—
155822002
—
AR
05
—
3720439
—
TN
01
—
8P412
BCBS AR
AR
Enumeration date
06/04/2006
Last updated
03/11/2024
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