Healthcare Provider Details

I. General information

NPI: 1770624108
Provider Name (Legal Business Name): MARTINA OKWUEZE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 TENNESSEE AVE S
PARSONS TN
38363-3700
US

IV. Provider business mailing address

969 TENNESSEE AVE S
PARSONS TN
38363-3700
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-1236
  • Fax:
Mailing address:
  • Phone: 731-847-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD0000039401
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD0000039401
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: