Healthcare Provider Details
I. General information
NPI: 1972555696
Provider Name (Legal Business Name): BARBARA OBRIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/17/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8000 CENTERVIEW PKWY SUITE 300
CORDOVA TN
38018-4254
US
IV. Provider business mailing address
8000 CENTERVIEW PKWY SUITE 300
CORDOVA TN
38018-4254
US
V. Phone/Fax
- Phone: 901-747-1111
- Fax: 901-747-1137
- Phone: 901-747-1111
- Fax: 901-747-1137
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084N0400X |
| Taxonomy | Neurology Physician |
| License Number | 18000 |
| License Number State | TN |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 4170696 |
| Identifier Type | OTHER |
| Identifier State | TN |
| Identifier Issuer | BC BS TN |
| # 2 | |
| Identifier | 4227362 |
| Identifier Type | OTHER |
| Identifier State | TN |
| Identifier Issuer | BCBS TN |
| # 3 | |
| Identifier | 18000 |
| Identifier Type | MEDICAID |
| Identifier State | TN |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: