Provider Demographics
NPI:1396867875
Name:ATUBRA, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:ATUBRA
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 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:310 25TH AVE N
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1515
Practice Address - Country:US
Practice Address - Phone:615-329-0195
Practice Address - Fax:615-329-0211
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41912208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78615Medicare UPIN