MEDICARE: DR. NATHANIEL BROOKS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25651	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4129684	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1073569489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL BROOKS JR. MD

Provider Business Mailing Address
First Line	:	208 NORTH AVE
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-1816
Country	:	US
Telephone Number	:	731-989-2116
Fax Number	:	731-989-7607

Provider Business Practice Location Address
First Line	:	208 NORTH AVE
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-1816
Country	:	US
Telephone Number	:	731-989-2116
Fax Number	:	731-989-7607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/22/2008

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