Provider Demographics
NPI:1952749483
Name:OBGYN CONSULTANTS OF MEMPHIS
Entity Type:Organization
Organization Name:OBGYN CONSULTANTS OF MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:OGONNA
Authorized Official - Last Name:ORAEDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-274-9717
Mailing Address - Street 1:9891 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6978
Mailing Address - Country:US
Mailing Address - Phone:901-274-9717
Mailing Address - Fax:901-684-2008
Practice Address - Street 1:6025 WALNUT GROVE
Practice Address - Street 2:SUITE 316
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-274-9717
Practice Address - Fax:901-684-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3842008Medicaid
TNQ008198Medicaid
TN3842008Medicaid