Provider Demographics
NPI:1326277575
Name:MID SOUTH PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:MID SOUTH PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EJAZ
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-681-9895
Mailing Address - Street 1:PO BOX 381554
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1554
Mailing Address - Country:US
Mailing Address - Phone:901-681-9895
Mailing Address - Fax:901-377-3633
Practice Address - Street 1:3173 KIRBY WHITTEN RD
Practice Address - Street 2:STE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-2881
Practice Address - Country:US
Practice Address - Phone:901-681-9895
Practice Address - Fax:901-377-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty