Provider Demographics
NPI:1043213150
Name:OBI, PATRICIA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RENEE
Last Name:OBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:RENEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:168 W UNIVERSITY PKWY
Mailing Address - Street 2:STE A&B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1624
Mailing Address - Country:US
Mailing Address - Phone:731-512-0043
Mailing Address - Fax:731-512-0015
Practice Address - Street 1:168 W UNIVERSITY PKWY
Practice Address - Street 2:STE A&B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1624
Practice Address - Country:US
Practice Address - Phone:731-512-0043
Practice Address - Fax:731-512-0015
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN017895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377799Medicaid
TN621861114OtherTAX ID
TN3377799Medicaid
TNE13054Medicare UPIN