Provider Demographics
NPI:1427299247
Name:MARTIN LEE & PAGE OBGYN, PLC
Entity type:Organization
Organization Name:MARTIN LEE & PAGE OBGYN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-4500
Mailing Address - Street 1:6286 BRIARCREST AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4023
Mailing Address - Country:US
Mailing Address - Phone:901-752-4500
Mailing Address - Fax:901-260-5606
Practice Address - Street 1:6286 BRIARCREST AVE STE 308
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-752-4500
Practice Address - Fax:901-260-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710007Medicare PIN