Provider Demographics
NPI:1679702260
Name:VESTER, GRACE AMY SEECHARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:AMY SEECHARAN
Last Name:VESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:AMY
Other - Last Name:SEECHARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8500
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:814 JEFFERSON AVE RM 111
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-5041
Practice Address - Country:US
Practice Address - Phone:901-222-9664
Practice Address - Fax:901-222-7992
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST2133207Q00000X
MS21715207Q00000X
TN49254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine