Healthcare Provider Details

I. General information

NPI: 1265766877
Provider Name (Legal Business Name): OBSTETRICS AND MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 310
MEMPHIS TN
38119-5213
US

IV. Provider business mailing address

6005 PARK AVE STE 310
MEMPHIS TN
38119-5213
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-0833
  • Fax: 901-763-3831
Mailing address:
  • Phone: 901-763-0833
  • Fax: 901-763-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD 39957
License Number StateTN

VIII. Authorized Official

Name: MS. LEIGH WATSON
Title or Position: CONSULTANT
Credential: MS, RHIA
Phone: 615-772-4427