Healthcare Provider Details

I. General information

NPI: 1609808062
Provider Name (Legal Business Name): G NICHOLAS VERNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. G. NICHOLAS VERNE

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-4541
  • Fax: 901-545-8122
Mailing address:
  • Phone: 901-515-4541
  • Fax: 901-545-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.089794
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number60200
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: