Individual provider Active NPI

Mary Cecelia Portis, M.D.

  • Gastroenterology Physician
  • Memphis, TN
National Provider Identifier
1265415822
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD26819 Issued in TN
Practice address
6005 Park Ave
Suite 323B
Memphis, TN 38119-5202
Phone
(901) 684-5500
Fax
(901) 684-5518
NPI assigned
Nov 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD26819 TN Primary

Addresses

Primary practice location

6005 Park Ave
Suite 323B
Memphis, TN 38119-5202

Mailing address

6005 Park Ave
Suite 323B
Memphis, TN 38119-5202
Phone (901) 684-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26819TNMDGastroenterology Physician
MD26819TNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
G I Diagnostic and Therapeutic Center LLC Gastroenterology Current Accepting new patients

Locations

7668 Airways Blvd
Bldg 2
Southaven, MS 38671
Phone (901) 766-9490

1310 Wolf Park Dr
Germantown, TN 38138
Phone (901) 624-5151

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1265415822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "SUITE 323B",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195202",
            "telephone_number": "901-684-5500",
            "fax_number": "901-684-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "SUITE 323B",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195202",
            "telephone_number": "901-684-5500",
            "fax_number": "901-684-5518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTIS",
        "first_name": "MARY",
        "middle_name": "CECELIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "MD26819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.