Provider Demographics
NPI:1336454313
Name:THE AKESO GROUP
Entity type:Organization
Organization Name:THE AKESO GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-797-9711
Mailing Address - Street 1:5744 NANJACK CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2061
Mailing Address - Country:US
Mailing Address - Phone:901-797-9711
Mailing Address - Fax:901-797-9771
Practice Address - Street 1:5744 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2061
Practice Address - Country:US
Practice Address - Phone:901-797-9711
Practice Address - Fax:901-797-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82822163W00000X
TN20634207L00000X
MSR864279367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706284OtherAPPLICATIONS PROCESSING