Provider Demographics
NPI:1164166336
Name:ROSS, CHAD MONTGOMERY (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MONTGOMERY
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-226-4003
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7736 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5306
Practice Address - Country:US
Practice Address - Phone:662-772-3700
Practice Address - Fax:662-772-3719
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2025-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN74370207Q00000X
MS35291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine