Primary Care - South Limited

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PRIMARY CARE - SOUTH LIMITED

Practice address

1385 South Highland Ave
Suite B-1
Jackson, TN 38301

Phone

(731) 427-0470

Fax

(731) 427-0995

NPI assigned

Jul 16, 2018

Last updated

Sep 6, 2024By 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

Malcom Matthew Ingram

Title

Owner

Phone

(731) 427-0470

Specialties & licenses 1

Addresses

Other names 1

• Primary Care South LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan C Martin, FNP-BC

  • Primary Care Nurse Practitioner
  • Jackson, TN
  • NPI 1245227313
  Medicare reassignment NPD
• Lisa Morris, NP

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1720732175
  Medicare reassignment NPD
• Kirkland Sturgis, FNP-C

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1851983555
  Medicare reassignment NPD
• Diane Maxwell, NP

  • Nurse Practitioner
  • Jackson, TN
  • NPI 1063111672
  NPD (past)
• Nada Salloukh, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1487490975
  NPD (past)

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

{
    "created_epoch": "1531699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1366928087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 SOUTH HIGHLAND AVE",
            "address_2": "SUITE B-1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38301",
            "telephone_number": "731-427-0470",
            "fax_number": "731-427-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 SOUTH HIGHLAND AVE",
            "address_2": "SUITE B-1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38301",
            "telephone_number": "731-427-0470",
            "fax_number": "731-427-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE - SOUTH LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-16",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "MALCOM",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-427-0470"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care South LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Preventagenix LLC
• Katie Beth Price-Verdell, PSY.D.
• James Alfred Price Jr., MD
• William Bradford Priester, M.D.
• Primary Care - Bemis, LLC
• Primary Care Clinic of Jackson
• Primary Care of Bemis & Associates, PLLC
• Primary Care Specialists of West Tennessee, LLC
• Primary Care Specialists South PLLC
• Alexandria Hearn Prince, FNP-C

• Primary Care Clinic/Center in Jackson, TN
• Providers in Jackson, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.