Healthcare Provider Details

I. General information

NPI: 1184612244
Provider Name (Legal Business Name): JODY S BRAHNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 VIRGINIA WAY SUITE 300
BRENTWOOD TN
37027-7541
US

IV. Provider business mailing address

5301 VIRGINIA WAY SUITE 300
BRENTWOOD TN
37027-7541
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-4474
  • Fax: 615-234-3774
Mailing address:
  • Phone: 615-221-4474
  • Fax: 615-234-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35086760
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number043560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: