Healthcare Provider Details

I. General information

NPI: 1366452484
Provider Name (Legal Business Name): JASON M VANATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE, 4 SHORB TOWER
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

9035 TELLURIDE CV
GERMANTOWN TN
38138-8400
US

V. Phone/Fax

Practice location:
  • Phone: 901-478-9183
  • Fax: 901-478-8957
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number42475
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61282
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number42475
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: