1528011426 NPI number — MR. BRANDON DESHON TEEFTALLER APN

Table of content: MR. BRANDON DESHON TEEFTALLER APN (NPI 1528011426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528011426 NPI number — MR. BRANDON DESHON TEEFTALLER APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEEFTALLER
Provider First Name:
BRANDON
Provider Middle Name:
DESHON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1528011426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 21ST AVE S
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37212-4942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-301-8681
Provider Business Mailing Address Fax Number:
615-301-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 21ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-301-8681
Provider Business Practice Location Address Fax Number:
615-301-1603
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APN7967 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 7967 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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