Healthcare Provider Details

I. General information

NPI: 1457649139
Provider Name (Legal Business Name): OLENA DOROKHOVA M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 VIRGINIA WAY SUITE 300
BRENTWOOD TN
37027-7541
US

IV. Provider business mailing address

5301 VIRGINIA WAY SUITE 300
BRENTWOOD TN
37027-7541
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-4447
  • Fax: 615-234-2511
Mailing address:
  • Phone: 615-695-4977
  • Fax: 615-263-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number076978
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number076978
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number076978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: