Healthcare Provider Details

I. General information

NPI: 1780497792
Provider Name (Legal Business Name): SUGAR PROS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 PARK AVE STE 202
MEMPHIS TN
38119-3547
US

IV. Provider business mailing address

875 W POPLAR AVENUE, STE 24, #102
COLLIERVILLE TN
38017
US

V. Phone/Fax

Practice location:
  • Phone: 901-468-3105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERECHI OGWO
Title or Position: MANAGER
Credential: M.D
Phone: 901-468-3105