MEDICARE: DR. ANGIE JEAN CHILDERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	200600714	NC
2	207VX0000X	Obstetrics Physician	MD0000039560	TN
3	207VX0000X	Obstetrics Physician	200600714	NC
4	207Q00000X	Family Medicine Physician	MD0000039560	TN

General Provider Information

NPI Number	:	1750391116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGIE JEAN CHILDERS MD

Provider Business Mailing Address
First Line	:	2595 CENTRAL AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-5905
Country	:	US
Telephone Number	:	901-260-8551
Fax Number	:	901-260-8590

Provider Business Practice Location Address
First Line	:	2569 DOUGLASS AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38114-2532
Country	:	US
Telephone Number	:	901-271-6200
Fax Number	:	901-260-8590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	01/22/2025

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