Healthcare Provider Details

I. General information

NPI: 1043213150
Provider Name (Legal Business Name): PATRICIA RENEE OBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA RENEE BROWN MD

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 W UNIVERSITY PKWY STE A&B
JACKSON TN
38305-1624
US

IV. Provider business mailing address

168 W UNIVERSITY PKWY STE A&B
JACKSON TN
38305-1624
US

V. Phone/Fax

Practice location:
  • Phone: 731-512-0043
  • Fax: 731-512-0015
Mailing address:
  • Phone: 731-512-0043
  • Fax: 731-512-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number017895
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: