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General NPI Number Information
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NPI Number | 1831226000
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Entity Type | Organization
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Legal Business Name | PRIME OBSTETRICS & GYNECOLOGY, PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 WOLVERINE TRL SUITE 200
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City | SMYRNA
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State | TN
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Zip | 37167-5656
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Country | US
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Telephone | 615-459-5228
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Fax | 615-459-5370
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | SMYRNA
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State | TN
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Zip | 37167-0305
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Country | US
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Telephone | 615-459-5228
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Fax | 615-459-5370
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AFAM C IKEJIANI
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Credential | M.D.
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Telephone | 615-459-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD26182
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License Number State | TN
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