Healthcare Provider Details

I. General information

NPI: 1235201617
Provider Name (Legal Business Name): THE WEST CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 STATE DR
CORINTH MS
38834-9324
US

IV. Provider business mailing address

7714 POPLAR AVE STE 200
GERMANTOWN TN
38138-3941
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-3694
  • Fax: 662-286-3853
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-922-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M GRAVES
Title or Position: CEO
Credential:
Phone: 901-683-0055