Basic Information
| Provider Information | |||||||||
| NPI: | 1790715852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMPHIS SURGERY ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6029 WALNUT GROVE RD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017261056 | ||||||||
| FaxNumber: | 9017265867 | ||||||||
| Practice Location | |||||||||
| Address1: | 6029 WALNUT GROVE RD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017261056 | ||||||||
| FaxNumber: | 9017265867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | RANDOLPH | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9017261056 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3703067 | 05 | TN | MEDICAID | CE0722 | 01 | TN | RAILROAD MEDICARE | OTHER |