Healthcare Provider Details

I. General information

NPI: 1649710666
Provider Name (Legal Business Name): ROBINSON O'HARA-RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 09/02/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 UFFELMAN DR
CLARKSVILLE TN
37043-6566
US

IV. Provider business mailing address

803 RIVER RUN
CLARKSVILLE TN
37043-6042
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-6305
  • Fax: 931-245-1153
Mailing address:
  • Phone: 305-720-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3179
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3179
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: