Mid South Wellness Center, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD0000028821 Issued in TN

Legal business name

MID SOUTH WELLNESS CENTER, INC

Practice address

7662 Highway 51North
Suite 2
Millington, TN 38053

Phone

(901) 873-2555

Fax

(901) 873-2561

NPI assigned

Jan 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Ray Floyd, MDNPI 1083779235

Title

Owner

Phone

(901) 873-2555

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Ray Floyd, MD

  • Family Medicine Physician
  • Millington, TN
  • NPI 1083779235
  NPD (past) Authorized official

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1932258787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7662 HIGHWAY 51NORTH",
            "address_2": "SUITE 2",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "38053",
            "telephone_number": "901-873-2555",
            "fax_number": "901-873-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7662 HIGHWAY 51NORTH",
            "address_2": "SUITE 2",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "38053",
            "telephone_number": "901-873-2555",
            "fax_number": "901-873-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH WELLNESS CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-873-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000028821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3378384",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Geraldine Webber McCoy, MSN, APRN, FNP-C
• William L Medlock, HIPAA TAXONOMY 246Z0
• Melton Telepsychiatry Services
• Memphis Vamc
• Nadia Menard, PT
• Tina Rena Miller, MSN APRN NP-C
• Millington Family Medicine, Inc.
• Millington Opco LP
• Millington Pediatrics, PC
• Tamara Jonee Mitchell, PHARM.D.

• Family Medicine Physician in Millington, TN
• Providers in Millington, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.