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General NPI Number Information
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NPI Number | 1407121551
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Entity Type | Organization
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Legal Business Name | AMEN CLINIC PC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 150 MURRAY GUARD DR
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City | JACKSON
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State | TN
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Zip | 38305
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Country | US
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Telephone | 731-300-3168
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Fax | 731-300-3169
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Provider Business Mailing Address
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Address Line | PO BOX 12485
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City | JACKSON
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State | TN
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Zip | 38308-0143
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Country | US
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Telephone | 731-300-3168
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Fax | 731-300-3169
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Authorized Official
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Title or Position | OWNER
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Name | EZEKIEL O ADETUNJI
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Credential | MD
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Telephone | 731-300-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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