Healthcare Provider Details

I. General information

NPI: 1902277429
Provider Name (Legal Business Name): THE AKESO GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5744 NANJACK CIR
MEMPHIS TN
38115-2061
US

IV. Provider business mailing address

11890 METZ PL
EADS TN
38028-6984
US

V. Phone/Fax

Practice location:
  • Phone: 901-854-7363
  • Fax:
Mailing address:
  • Phone: 901-854-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHNATHAN ISOM
Title or Position: CEO
Credential: MD
Phone: 901-854-7363