Healthcare Provider Details

I. General information

NPI: 1033036934
Provider Name (Legal Business Name): EMMANUEL JOHNBOSCO MAMAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CHURCH ST
NASHVILLE TN
37236-4400
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-5555
  • Fax:
Mailing address:
  • Phone: 615-284-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number247261
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: