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General NPI Number Information
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NPI Number | 1164594081
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Entity Type | Organization
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Legal Business Name | THE WEST CLINIC PLLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 240 GRANDVIEW DRIVE
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City | BRIGHTON
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State | TN
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Zip | 38011-4253
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Country | US
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Telephone | 901-475-0678
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Fax | 901-475-3927
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Provider Business Mailing Address
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Address Line | 7714 POPLAR AVE STE 200
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City | GERMANTOWN
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State | TN
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Zip | 38138-3941
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Country | US
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Telephone | 901-683-0055
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Fax | 901-922-6722
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN M GRAVES
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Credential |
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Telephone | 901-683-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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