Healthcare Provider Details

I. General information

NPI: 1629281712
Provider Name (Legal Business Name): SAXTON HEART CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 PRIMACY PKWY STE 125
MEMPHIS TN
38119-5701
US

IV. Provider business mailing address

6055 PRIMACY PKWY STE 125
MEMPHIS TN
38119-5701
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-9998
  • Fax: 901-761-9991
Mailing address:
  • Phone: 901-761-9998
  • Fax: 901-761-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD11627
License Number StateTN

VIII. Authorized Official

Name: GRADY L SAXTON SR.
Title or Position: OWNER
Credential: MD
Phone: 901-761-9998