Provider Demographics
NPI:1750391116
Name:CHILDERS, ANGIE JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:JEAN
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGIE
Other - Middle Name:JEAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:2569 DOUGLASS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-2532
Practice Address - Country:US
Practice Address - Phone:901-271-6200
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600714207Q00000X, 207VX0000X
TNMD0000039560207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50537Medicare UPIN