Healthcare Provider Details

I. General information

NPI: 1487737912
Provider Name (Legal Business Name): VIP MIDSOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 HARTSVILLE PIKE
GALLATIN TN
37066
US

IV. Provider business mailing address

648 HARTSVILLE PIKE
GALLATIN TN
37066-2523
US

V. Phone/Fax

Practice location:
  • Phone: 615-451-9246
  • Fax: 615-452-9410
Mailing address:
  • Phone: 615-451-9246
  • Fax: 615-452-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BRANHAM
Title or Position: PRESIDENT
Credential:
Phone: 615-452-7862