Organization
MIDSOUTH INDEPENDENT GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM R BREEN JR. (GROUP MANAGER)
(901) 832-4494
Entity
Organization
Contact information
Practice address
6401 POPLAR AVE STE 604, MEMPHIS, TN 38119-4808
(901) 474-2402
(901) 328-5746
Mailing address
6401 POPLAR AVE STE 604, MEMPHIS, TN 38119-4808
(901) 474-2402
(901) 249-4070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q061176
—
TN
Enumeration date
09/29/2020
Last updated
11/29/2023
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