Healthcare Provider Details

I. General information

NPI: 1740223460
Provider Name (Legal Business Name): BARTON BORG THRASHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 HIGHWAY 64 STE 4
OAKLAND TN
38060-3402
US

IV. Provider business mailing address

6685 HIGHWAY 64 STE 4
OAKLAND TN
38060-3402
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-9955
  • Fax: 901-465-9955
Mailing address:
  • Phone: 901-465-9955
  • Fax: 901-465-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 023517
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: