Healthcare Provider Details

I. General information

NPI: 1770510687
Provider Name (Legal Business Name): ARLINGTON MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 HIGHWAY 70 SUITE 101
ARLINGTON TN
38002-9754
US

IV. Provider business mailing address

11121 HIGHWAY 70 SUITE 101
ARLINGTON TN
38002-9754
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-0211
  • Fax: 901-867-0759
Mailing address:
  • Phone: 901-867-0211
  • Fax: 901-867-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29373
License Number StateTN

VIII. Authorized Official

Name: DR. HENRY ENYENIHI
Title or Position: OWNER
Credential: MD
Phone: 901-867-0211