Provider Demographics
NPI:1487796264
Name:GERMANTOWN OB-GYN GROUP PLLC
Entity type:Organization
Organization Name:GERMANTOWN OB-GYN GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:LU
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-753-4200
Mailing Address - Street 1:7516 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3847
Mailing Address - Country:US
Mailing Address - Phone:901-753-4200
Mailing Address - Fax:901-753-4463
Practice Address - Street 1:7516 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3847
Practice Address - Country:US
Practice Address - Phone:901-753-4200
Practice Address - Fax:901-753-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012168207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377257Medicare PIN