Provider Demographics
NPI:1265766877
Name:OBSTETRICS AND MEDICINE PLLC
Entity type:Organization
Organization Name:OBSTETRICS AND MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RHIA
Authorized Official - Phone:615-772-4427
Mailing Address - Street 1:6005 PARK AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5213
Mailing Address - Country:US
Mailing Address - Phone:901-763-0833
Mailing Address - Fax:901-763-3831
Practice Address - Street 1:6005 PARK AVE STE 310
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5213
Practice Address - Country:US
Practice Address - Phone:901-763-0833
Practice Address - Fax:901-763-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 39957207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32339Medicare UPIN