DR. GINA VICK BRAY (NPI# 1255338984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255338984 |
| Entity Type | Individual |
| Full Name | DR. GINA VICK BRAY |
| Credential | DO |
| Practice Address |
187 Stateline Rd E Suite 10 Southaven MS 38671-1704 |
| Mailing Address |
Po Box 1369 Southaven MS 38671-0014 |
| Practice Telephone | 6623425353 |
| Practice Fax Number | 6623939753 |
| Mailing Telephone | 6623425353 |
| Mailing Fax Number | 6623939753 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-04-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 15380 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0118418 | 05 |
| Street Address |
187 STATELINE RD E SUITE 10 |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-1704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275727299 | Desoto Family Counseling Center, Pllc | Counselor | 187 Stateline Rd E, Suite 17, Southaven, MS 38671-1704 | 2007-09-03 |
| 1912057415 | Ruth Ouzts Cash | Counselor | 187 Stateline Rd E, Suite 17, Southaven, MS 38671-1704 | 2007-01-10 |
| 1558382200 | Desoto Osteopathic | Internal Medicine | 187 Stateline Rd E, Suite #10, Southaven, MS 38671-1704 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952809014 | Desoto Adult Medicine Associates, Pllc | Internal Medicine | 7900 Ariways Blvd, Bldg C Suite 1, Southaven, MS 38671-4113 | 2018-01-24 |
| 1134367311 | Dr Kiandokht Partovi PC Inc | Internal Medicine | 5410 Windy Ridge Dr, Southaven, MS 38671-6450 | 2009-01-27 |
| 1609035468 | Internal Medicine Group of The Midsouth Pllc | Internal Medicine | 391 Southcrest Cl, Suite 210, Southaven, MS 38671 | 2008-06-06 |
| 1841369907 | Sunil Malhotra | Internal Medicine | 470 Goodman Road, Southaven, MS 38671-9557 | 2006-11-06 |
| 1194894147 | Midsouth Medicine | Internal Medicine | 2149 Stateline Rd W, Southaven, MS 38671-1222 | 2006-11-06 |
| 1649363656 | Ki M Chang | Internal Medicine | 7165 Getwell Road, Bldg F, Southaven, MS 38762 | 2006-10-02 |
| 1053402610 | Mahfuzur Rahman | Internal Medicine | 728 Goodman Rd E, Ste 2, Southaven, MS 38671-9530 | 2006-09-27 |
| 1083719199 | Lily Herbert | Internal Medicine | 7680 Airways Blvd, Southaven, MS 38671-5304 | 2006-09-13 |
| 1346257771 | Sabra F Drake | Internal Medicine | 176 Goodman Rd W, Southaven, MS 38671-9405 | 2006-08-01 |
| 1023535838 | Shan Shah | Internal Medicine | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2017-08-23 |
| Find all providers in SOUTHAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.