Provider Demographics
NPI:1164530911
Name:AKINS, DERENE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:DERENE
Middle Name:ELLEN
Last Name:AKINS
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 1:6799 GREAT OAKS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2588
Mailing Address - Country:US
Mailing Address - Phone:901-821-8300
Mailing Address - Fax:901-259-9793
Practice Address - Street 1:6799 GREAT OAKS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-2588
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:901-259-9793
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0128000OtherBLUE CROSS
TN3382217Medicaid
110049108OtherRAILROAD MEDICARE
110049108OtherRAILROAD MEDICARE