Healthcare Provider Details

I. General information

NPI: 1861244162
Provider Name (Legal Business Name): CLAIRE MARIE TIBBETTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

251 S CLAYBROOK ST STE A206
MEMPHIS TN
38104-3539
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-3197
  • Fax:
Mailing address:
  • Phone: 901-448-3197
  • Fax: 901-516-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: