Mid South Vascular Clinic

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

06816 Issued in TN

Legal business name

MID SOUTH VASCULAR CLINIC

Practice address

6027 Walnut Grove Rd
Suite 205
Memphis, TN 38120-2145

Phone

(901) 683-4471

Fax

(901) 683-3915

NPI assigned

Jul 22, 2006

Last updated

Jul 8, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jesse T Davis, MD

Title

Owner

Phone

(901) 683-4471

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1003837279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6027 WALNUT GROVE RD",
            "address_2": "SUITE 205",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202145",
            "telephone_number": "901-683-4471",
            "fax_number": "901-683-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6027 WALNUT GROVE RD",
            "address_2": "SUITE 205",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202145",
            "telephone_number": "901-683-4471",
            "fax_number": "901-683-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH VASCULAR CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-683-4471",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "06816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3149502",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mid South Psychiatry, PLLC
• Mid South Regional Thoracic Center, LLC
• Mid South Residential Care Center
• Mid South Senior Care, LLC (Mid-South Senior Care)
• Mid South Supportive Living, LLC
• Mid-South ABA Therapy
• Mid-South Area Residential Services
• Mid-South Cardiovascular Center, LLC
• Mid-South Education and Behavior Solutions, LLC
• Mid-South Foot and Ankle Specialists, PLLC

• Cardiovascular Disease Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Cardiovascular Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.