Healthcare Provider Details

I. General information

NPI: 1922093574
Provider Name (Legal Business Name): LEE ANNE FAULKNER OBRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 MARYLAND WAY STE 301
BRENTWOOD TN
37027-7513
US

IV. Provider business mailing address

5111 MARYLAND WAY STE 301
BRENTWOOD TN
37027-7513
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-4256
  • Fax: 615-661-4253
Mailing address:
  • Phone: 615-661-4256
  • Fax: 615-661-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26244
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: