Healthcare Provider Details

I. General information

NPI: 1801009089
Provider Name (Legal Business Name): JAMES ERIC GARDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADISON AVE SUITE 300
MEMPHIS TN
38104-6492
US

IV. Provider business mailing address

PO BOX 38238
GERMANTOWN TN
38183-0238
US

V. Phone/Fax

Practice location:
  • Phone: 901-861-8088
  • Fax: 901-861-8082
Mailing address:
  • Phone: 901-861-8088
  • Fax: 901-861-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35417
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: