Healthcare Provider Details

I. General information

NPI: 1033224258
Provider Name (Legal Business Name): OLGA L URIBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COOK DR
ATHENS TN
37303-3485
US

IV. Provider business mailing address

817 COOK DR
ATHENS TN
37303-3485
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-3394
  • Fax: 423-745-6779
Mailing address:
  • Phone: 423-745-3394
  • Fax: 423-745-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number056778
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000045234
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: