Healthcare Provider Details

I. General information

NPI: 1104877703
Provider Name (Legal Business Name): MEDICAL SPECIALTY CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MEDICAL CENTER DR
JACKSON TN
38301-3949
US

IV. Provider business mailing address

27 MEDICAL CENTER DR
JACKSON TN
38301-3949
US

V. Phone/Fax

Practice location:
  • Phone: 731-424-1001
  • Fax: 731-424-0774
Mailing address:
  • Phone: 731-424-1001
  • Fax: 731-424-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29728
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: MS. SANDY V MORRIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 731-424-1001