Individual
FAZAL M MANEJWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7900 AIRWAYS BLVD STE 2, SOUTHAVEN, MS 38671-4113
(901) 454-1111
Mailing address
8110 N BROTHER BLVD STE 200, BARTLETT, TN 38133-2760
(901) 255-5221
(901) 373-4511
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD027081
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122091
—
MS
01
—
3090888
BCBS
TN
Enumeration date
07/07/2006
Last updated
04/15/2020
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