Healthcare Provider Details

I. General information

NPI: 1740277821
Provider Name (Legal Business Name): TRANSSOUTH HEALTH CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PHYSICIANS DR
JACKSON TN
38305-2071
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 731-661-0086
  • Fax: 731-661-0281
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000070
License Number StateTN

VIII. Authorized Official

Name: AIMEE CATHLEEN JUDY
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 901-737-4665