Provider Demographics
NPI:1669683835
Name:BROWN, BOBBIE JEAN (MLT)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-0016
Mailing Address - Country:US
Mailing Address - Phone:931-200-2348
Mailing Address - Fax:
Practice Address - Street 1:148 TURNER RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-0016
Practice Address - Country:US
Practice Address - Phone:931-200-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNML0000021592246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory