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General NPI Number Information
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NPI Number | 1972782670
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Entity Type | Organization
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Legal Business Name | OB GYN CENTERS OF MEMPHIS,MPLLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 1264 WESLEY DR STE 402
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City | MEMPHIS
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State | TN
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Zip | 38116-6447
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Country | US
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Telephone | 901-396-5577
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Fax | 901-396-6538
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Provider Business Mailing Address
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Address Line | 1264 WESLEY DR STE 402
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City | MEMPHIS
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State | TN
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Zip | 38116-6447
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Country | US
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Telephone | 901-396-5577
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Fax | 901-396-6538
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Authorized Official
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Title or Position | AOM
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Name | MS. VIVIAN SMITH MALONE
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Credential |
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Telephone | 901-396-5577
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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 | 207V00000X
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License Number State | TN
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