Organization
SOUTH MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUWATOYIN JIMMY AGBAOSI MD (PRESIDENT)
(901) 570-7438
Entity
Organization
Contact information
Practice address
1300 WESLEY DR, MEMPHIS, TN 38116-6426
(901) 570-7438
Mailing address
PO BOX 16384, MEMPHIS, TN 38186-0384
(901) 570-7438
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1530261
—
TN
Enumeration date
10/22/2012
Last updated
06/03/2016
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