Provider Demographics
NPI:1720321060
Name:OGWO, CHERECHI C (MD)
Entity Type:Individual
Prefix:
First Name:CHERECHI
Middle Name:C
Last Name:OGWO
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 1:875 W POPLAR AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2598
Mailing Address - Country:US
Mailing Address - Phone:901-744-3362
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:STE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4736
Practice Address - Country:US
Practice Address - Phone:901-448-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53913207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ052312Medicaid