Healthcare Provider Details

I. General information

NPI: 1609129139
Provider Name (Legal Business Name): SOUTH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 KATE BOND RD
BARTLETT TN
38133-4003
US

IV. Provider business mailing address

PO BOX 16384
MEMPHIS TN
38186-0384
US

V. Phone/Fax

Practice location:
  • Phone: 901-820-7000
  • Fax:
Mailing address:
  • Phone: 901-570-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: OLUWATOYIN JIMMY AGBAOSI
Title or Position: PROVIDER/OWNER
Credential: MD
Phone: 901-203-2020