Healthcare Provider Details

I. General information

NPI: 1528477056
Provider Name (Legal Business Name): BARBARA F KACZMARSKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 COLLOREDO BLVD
SHELBYVILLE TN
37160-2774
US

IV. Provider business mailing address

880 COLLOREDO BLVD
SHELBYVILLE TN
37160-2774
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-8111
  • Fax: 931-685-8007
Mailing address:
  • Phone: 931-685-8111
  • Fax: 931-685-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD51897
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD28127
License Number StateTN

VIII. Authorized Official

Name: DR. BARBARA F. KACZMARSKA
Title or Position: OWNER
Credential: MD
Phone: 931-685-8111