Healthcare Provider Details

I. General information

NPI: 1407299944
Provider Name (Legal Business Name): KELECHI OHAYAGHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 GOODMAN RD
OLIVE BRANCH MS
38654-2103
US

IV. Provider business mailing address

920 MADISON AVENUE SUITE 447
MEMPHIS TN
38163
US

V. Phone/Fax

Practice location:
  • Phone: 662-895-4900
  • Fax:
Mailing address:
  • Phone: 901-448-2302
  • Fax: 901-448-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25738
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: