Organization
DELTA CONVENIENT CARE PC
Active
Other names
Heart & Vascular Center of West Tennessee
Organization subpart
No
Provider details
NPI number
Authorized official
ELIE HAGE-KORBAN M.D. (AUTHORIZED OFFICIAL)
(731) 512-0104
Entity
Organization
Contact information
Practice address
17 CENTRE PLAZA DR, JACKSON, TN 38305-2862
(731) 512-0104
(731) 512-0938
Mailing address
17 CENTRE PLAZA DR, JACKSON, TN 38305-2862
(731) 512-0104
(731) 512-0938
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
TN
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3720558
—
TN
Enumeration date
06/03/2006
Last updated
06/05/2014
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