Healthcare Provider Details

I. General information

NPI: 1699210369
Provider Name (Legal Business Name): BELOVED MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 CLUB PKWY
CORDOVA TN
38016-5977
US

IV. Provider business mailing address

8045 CLUB PKWY
CORDOVA TN
38016-5977
US

V. Phone/Fax

Practice location:
  • Phone: 901-249-0847
  • Fax: 833-673-0465
Mailing address:
  • Phone: 901-249-0847
  • Fax: 833-673-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: IKECHUKWU EMEREUWAONU
Title or Position: OWNER
Credential: MD
Phone: 901-249-0847