Healthcare Provider Details

I. General information

NPI: 1053558403
Provider Name (Legal Business Name): MS. RHONDA DENISE OGBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAPLE ST W
FAYETTEVILLE TN
37334-3303
US

IV. Provider business mailing address

25 CASH RD
FAYETTEVILLE TN
37334-4845
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-4993
  • Fax:
Mailing address:
  • Phone: 931-937-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: