Provider Demographics
NPI:1033224258
Name:URIBE, OLGA L (MD)
Entity Type:Individual
Prefix:MISS
First Name:OLGA
Middle Name:L
Last Name:URIBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COOK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3485
Mailing Address - Country:US
Mailing Address - Phone:423-745-3394
Mailing Address - Fax:423-745-3396
Practice Address - Street 1:817 COOK DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3485
Practice Address - Country:US
Practice Address - Phone:423-745-3394
Practice Address - Fax:423-745-3396
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056778207V00000X
TNMD0000045234207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA696293295AMedicaid
TN1517492Medicaid
GA056778OtherSTATE MEDICAL LICENSE #
GA696293295CMedicaid
GA056778OtherSTATE MEDICAL LICENSE #
GAI44183Medicare UPIN
TN103I168071Medicare PIN
TNI44183Medicare UPIN