Modern Gynecology and Reproductive Health PC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

Legal business name

MODERN GYNECOLOGY AND REPRODUCTIVE HEALTH PC

Practice address

1407 Union Ave Ste 1401
Memphis, TN 38104-3667

Phone

(901) 701-1777

Fax

(901) 701-1778

NPI assigned

Jul 27, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Susan Northen Lacy, MD

Title

Physician Owner

Phone

(901) 289-0915

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1564185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572566400000",
    "number": "1962056036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 UNION AVE STE 1401",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043667",
            "telephone_number": "901-483-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 UNION AVE STE 1401",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043667",
            "telephone_number": "901-701-1777",
            "fax_number": "901-701-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN GYNECOLOGY AND REPRODUCTIVE HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-27",
        "last_updated": "2019-11-01",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "NORTHEN",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "901-289-0915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q053117",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Joshua Mock, PTA
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• Modern Health, LLC
• Modern Vascular of Memphis LLC
• Anice Robinson Modesto, PH.D.
• Vanraj M Modhvadia, DDS
• William Lee Moffatt III, MD

• Gynecology Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Gynecology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.