Provider Demographics
NPI:1588857148
Name:JAMES ERIC GARDNER, MD
Entity Type:Organization
Organization Name:JAMES ERIC GARDNER, MD
Other - Org Name:VASCULAR ACCESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-493-7821
Mailing Address - Street 1:PO BOX 38238
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0238
Mailing Address - Country:US
Mailing Address - Phone:901-493-7821
Mailing Address - Fax:901-860-9151
Practice Address - Street 1:400 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-6516
Practice Address - Country:US
Practice Address - Phone:901-493-7821
Practice Address - Fax:901-860-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN354172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG86796Medicare UPIN