MEDICARE: SUGAR PROS PC

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	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1780497792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUGAR PROS PC

Provider Business Mailing Address
First Line	:	875 W POPLAR AVENUE, STE 24, #102
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 PARK AVE STE 202
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3547
Country	:	US
Telephone Number	:	901-468-3105
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHERECHI OGWO
Credential	:	M.D
Telephone Number	:	901-468-3105

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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Directions to “SUGAR PROS PC ” Practice Location

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