Healthcare Provider Details

I. General information

NPI: 1336816388
Provider Name (Legal Business Name): METROPOLITAN CARDIOVASCULAR INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NONCONNAH BLVD
MEMPHIS TN
38132-2108
US

IV. Provider business mailing address

2386 CARTERS GROVE LN
GERMANTOWN TN
38138-4904
US

V. Phone/Fax

Practice location:
  • Phone: 901-337-1625
  • Fax:
Mailing address:
  • Phone: 901-596-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DWIGHT ANTHONY DISHMON
Title or Position: OWNER
Credential: MD
Phone: 901-596-4096