Healthcare Provider Details

I. General information

NPI: 1427276823
Provider Name (Legal Business Name): EJAZ VIRK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 KIRBY WHITTEN RD STE 104
MEMPHIS TN
38134
US

IV. Provider business mailing address

PO BOX 381554
GERMANTOWN TN
38183-1554
US

V. Phone/Fax

Practice location:
  • Phone: 901-524-1200
  • Fax:
Mailing address:
  • Phone: 901-524-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27846
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: