1275784217 NPI number — BRACKETT RHEUMATOLOGY PLLC

Table of content: (NPI 1275784217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275784217 NPI number — BRACKETT RHEUMATOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRACKETT RHEUMATOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIANS RX OF CHATTANOOGA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275784217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-884-0302
Provider Business Mailing Address Fax Number:
615-884-0305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6145 SHALLOWFORD RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-884-0302
Provider Business Practice Location Address Fax Number:
615-884-0305
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRACKETT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-893-6890

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0000004552 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2117357 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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