Healthcare Provider Details

I. General information

NPI: 1750410296
Provider Name (Legal Business Name): CHARICEM VENTURES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DAVY CROCKETT MALL
TRENTON TN
38382-2934
US

IV. Provider business mailing address

120 DAVY CROCKETT MALL
TRENTON TN
38382-2934
US

V. Phone/Fax

Practice location:
  • Phone: 731-855-3719
  • Fax: 731-855-1746
Mailing address:
  • Phone: 731-855-3719
  • Fax: 731-855-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. AYODELE ADELEKE OLUSANYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 731-855-3719