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General NPI Number Information
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NPI Number | 1649211418
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR SURGERY CLINIC, PLLC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6029 WALNUT GROVE RD SUITE 401
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City | MEMPHIS
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State | TN
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Zip | 38120-2112
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Country | US
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Telephone | 901-747-3066
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Fax | 901-747-2966
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Provider Business Mailing Address
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Address Line | 6029 WALNUT GROVE RD SUITE 401
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City | MEMPHIS
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State | TN
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Zip | 38120-2112
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Country | US
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Telephone | 901-747-3066
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Fax | 901-747-2966
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARVEY EDWARD GARRETT
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Credential | M.D.
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Telephone | 901-747-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 17068
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License Number State | TN
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