Healthcare Provider Details

I. General information

NPI: 1063307650
Provider Name (Legal Business Name): SOUTHERN VASCULAR AND PAIN SURGERY CENTER OLIVE BRANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 GERMANTOWN RD STE A
OLIVE BRANCH MS
38654-8532
US

IV. Provider business mailing address

921 DENT RD
EADS TN
38028-9704
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-0678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HODGKISS
Title or Position: MD/OWNER
Credential: MD
Phone: 901-350-0978