Provider Demographics
NPI:1205892437
Name:GIVENS, VANESSA (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 W SARAZENS CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-0807
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:7800 WOLF TRAIL CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1753
Practice Address - Country:US
Practice Address - Phone:901-682-9222
Practice Address - Fax:901-682-9505
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35115207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3863530Medicaid
3863530Medicare ID - Type Unspecified
H35796Medicare UPIN