Healthcare Provider Details

I. General information

NPI: 1477594679
Provider Name (Legal Business Name): SEAN FRANCIS BRAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 DUNLOP LN
CLARKSVILLE TN
37040-5015
US

IV. Provider business mailing address

2020 21ST AVE S SUITE 201
NASHVILLE TN
37212-4354
US

V. Phone/Fax

Practice location:
  • Phone: 931-502-1370
  • Fax:
Mailing address:
  • Phone: 615-269-0652
  • Fax: 615-269-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: