Healthcare Provider Details

I. General information

NPI: 1134181910
Provider Name (Legal Business Name): MAHER GHAWJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD SUITE 307
MEMPHIS TN
38120-2145
US

IV. Provider business mailing address

6027 WALNUT GROVE RD SUITE 307
MEMPHIS TN
38120-2145
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-0346
  • Fax: 901-682-7737
Mailing address:
  • Phone: 901-681-0346
  • Fax: 901-682-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number23751
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: