Healthcare Provider Details

I. General information

NPI: 1659728731
Provider Name (Legal Business Name): NATHANIEL BROOKS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 E CAMELBACK RD STE 625
PHOENIX AZ
85016-3458
US

IV. Provider business mailing address

2355 E CAMELBACK RD STE 625
PHOENIX AZ
85016-3458
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-626-7584
  • Fax: 480-210-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63624
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number86045
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: