Healthcare Provider Details

I. General information

NPI: 1265919005
Provider Name (Legal Business Name): KEJAC VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6263 POPLAR AVE STE 1052
MEMPHIS TN
38119-4736
US

IV. Provider business mailing address

PO BOX 1051
COLLIERVILLE TN
38027-1051
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-6157
  • Fax: 901-761-4145
Mailing address:
  • Phone: 901-761-6157
  • Fax: 901-761-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52959
License Number State

VIII. Authorized Official

Name: KELECHI UZOMA IWUJI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 901-761-6157