Provider Demographics
NPI:1528181468
Name:BIBILEISHVILI, ETERI (MD)
Entity Type:Individual
Prefix:DR
First Name:ETERI
Middle Name:
Last Name:BIBILEISHVILI
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:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-1049
Mailing Address - Country:US
Mailing Address - Phone:423-746-0366
Mailing Address - Fax:423-746-0398
Practice Address - Street 1:711 COOK DR STE 210
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-746-0366
Practice Address - Fax:423-746-0398
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN420482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000391Medicare PIN