Healthcare Provider Details

I. General information

NPI: 1134489024
Provider Name (Legal Business Name): BRADEN FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 CORRYTON RD
CORRYTON TN
37721-2630
US

IV. Provider business mailing address

PO BOX 108
CORRYTON TN
37721-0108
US

V. Phone/Fax

Practice location:
  • Phone: 865-247-6263
  • Fax: 865-247-6418
Mailing address:
  • Phone: 865-247-6263
  • Fax: 865-247-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD48081
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1510
License Number StateTN

VIII. Authorized Official

Name: JOE M BRADEN
Title or Position: OWNER/MEMBER
Credential: PA-C
Phone: 865-247-6263