Ezekiel Oladejo Adetunji, MD
Individual provider Active NPI Family Medicine Physician · Jackson, TN
NPI 1033302013 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1033302013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 44164 (TN)
- Practice address
- 150 Murray Guard Dr
Jackson, TN 38305-3609 - Phone
- (731) 300-3168
- Fax
- (731) 300-3169
- NPI assigned
- Aug 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Amen Clinic PC
Emergency Medical Care Facilities PC
Practice addresses (Care Compare)
150 Murray Guard Dr
Jackson, TN 38305-3609
Phone (731) 300-3168
620 Skyline Dr
Jackson, TN 38301-3923
Phone (731) 541-5000
Hospital & facility affiliations
- Jackson-Madison County General Hospital
- West Tennessee Healthcare Bolivar Hospital
- Avondale Health and Rehabilitation Center, LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081110000810 | TN | Practitioner - Family Practice |
4789743469 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44164 | TN | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| 001924 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Medical Care Facilities PC | Current |
Accepting new patients | |
| Amen Clinic PC | Family Medicine | Current |
Accepting new patients |
| Apogee Medical Group Tennessee PC | Past |
Accepting new patients |
Locations
650 Nuckolls Rd
Bolivar, TN 38008
Phone (731) 541-6834
175 Hospital Dr
Camden, TN 38320
Phone (731) 584-6135
139 Stonebridge Blvd
Jackson, TN 38305
Phone (731) 300-3168
150 Murray Guard Dr
Jackson, TN 38305
Phone (731) 201-2798
257 Bancorp South Pkwy
Jackson, TN 38305
Phone (731) 512-1283
620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923
367 Hospital Blvd
Jackson, TN 38305
Phone (731) 661-2000
161 Mount Pelia Rd
Martin, TN 38237
Phone (731) 587-4261
4039 Highland St
Ste 1
Milan, TN 38358
Phone (731) 723-3668
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GBJHBA/Endpoint/GBJHBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 44164 | TN | Yes |
| Family Medicine Physician | 207Q00000X | 001924 | GA |
Addresses
Primary practice location
150 Murray Guard Dr
Jackson, TN 38305-3609
Mailing address
139 Stonebridge Blvd
Jackson, TN 38305-2040
Phone (731) 300-3168
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3002429 | Medicaid | TN |
Other providers in Jackson, TN
- Kaleb Adams
- Mary Allison Adams
- Mary Lou Adams
- Trista Nicole Adams
- Alexander Aden
- Troy D Adkins
- William Bradford Adkins
- Advance Choice Home Care Incorporation LLC
- Advance Choice Home Care LLC
- Advance Pharmacy Services PLLC
All providers in Jackson, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.