1336454313 NPI number — THE AKESO GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336454313 NPI number — THE AKESO GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE AKESO GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336454313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5744 NANJACK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38115-2061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-797-9711
Provider Business Mailing Address Fax Number:
901-797-9771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5744 NANJACK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-2061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-797-9711
Provider Business Practice Location Address Fax Number:
901-797-9771
Provider Enumeration Date:
08/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ISOM
Authorized Official First Name:
JOHNATHAN
Authorized Official Middle Name:
MILTON
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
901-797-9711

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R864279 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 82822 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 20634 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3706284 . This is a "APPLICATIONS PROCESSING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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