Provider Demographics
NPI:1679063135
Name:INFECTIOUS DX SOLUTIONS PC
Entity type:Organization
Organization Name:INFECTIOUS DX SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBAOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-410-2159
Mailing Address - Street 1:PO BOX 18361
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38181-0361
Mailing Address - Country:US
Mailing Address - Phone:901-410-2159
Mailing Address - Fax:
Practice Address - Street 1:3025 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-410-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty