Healthcare Provider Details

I. General information

NPI: 1164339552
Provider Name (Legal Business Name): ENDOCRINE CLINICS & RESEARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 510
MEMPHIS TN
38104-7534
US

IV. Provider business mailing address

PO BOX 381604
GERMANTOWN TN
38183-1604
US

V. Phone/Fax

Practice location:
  • Phone: 901-580-7070
  • Fax: 704-270-6153
Mailing address:
  • Phone: 901-508-7070
  • Fax: 704-270-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EBENEZER A NYENWE
Title or Position: OWNER
Credential: MD
Phone: 518-892-7333