Provider Demographics
NPI:1083436505
Name:COMPREHENSIVE PEDIATRIC AND FAMILY CLINIC
Entity type:Organization
Organization Name:COMPREHENSIVE PEDIATRIC AND FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKEJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NP-BC
Authorized Official - Phone:901-826-4622
Mailing Address - Street 1:1779 KIRBY PKWY # 172
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3666
Mailing Address - Country:US
Mailing Address - Phone:901-826-4622
Mailing Address - Fax:
Practice Address - Street 1:1028 CRESTHAVEN RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3895
Practice Address - Country:US
Practice Address - Phone:901-249-7490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty