Healthcare Provider Details

I. General information

NPI: 1801909353
Provider Name (Legal Business Name): TIPTON PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 HIGHWAY 51 S SUITE 108
COVINGTON TN
38019-3635
US

IV. Provider business mailing address

1995 HIGHWAY 51 S SUITE 108
COVINGTON TN
38019-3635
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-7600
  • Fax: 901-476-3668
Mailing address:
  • Phone: 901-476-7600
  • Fax: 901-476-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NNEOMA UGORJI
Title or Position: OWNER
Credential: M.D.
Phone: 901-476-7600