Healthcare Provider Details

I. General information

NPI: 1356392567
Provider Name (Legal Business Name): PEGGY ANN O'CAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRIMACY PKWY
MEMPHIS TN
38119-0213
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8630
  • Fax: 901-302-2630
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number40884
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: