Healthcare Provider Details

I. General information

NPI: 1417962952
Provider Name (Legal Business Name): MOHAMAD R KARAMI-SICHANI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BENT CREEK LN
JACKSON TN
38305-2170
US

IV. Provider business mailing address

1804 HIGHWAY 45 BYP SUITE 604
JACKSON TN
38305-4436
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-6560
  • Fax: 731-660-8739
Mailing address:
  • Phone: 731-660-8759
  • Fax: 731-660-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMAD R KARAMI-SICHANI
Title or Position: OWNER
Credential: M.D.
Phone: 731-668-6560