Organization
SOUTHERN CARDIOVASCULAR PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN JOE ELLICHMAN M.D. (PRESIDENT)
(901) 259-2718
Entity
Organization
Contact information
Practice address
6401 POPLAR AVE STE 410, MEMPHIS, TN 38119
(901) 259-2718
(901) 259-1123
Mailing address
PO BOX 1135, COLLIERVILLE, TN 38027-1135
(901) 259-2718
(901) 259-1123
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526038
—
TN
Enumeration date
07/22/2008
Last updated
08/15/2018
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