Healthcare Provider Details

I. General information

NPI: 1548268592
Provider Name (Legal Business Name): SUHAIL M OBAJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HWY 30 W
NEW ALBANY MS
38652-3112
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 662-538-2535
  • Fax:
Mailing address:
  • Phone: 901-227-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberE-0595
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number20435
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number13747
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: