Healthcare Provider Details

I. General information

NPI: 1457092314
Provider Name (Legal Business Name): BRANDON ADAM BLOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 HIGHWAY 43 N STE 310
ETHRIDGE TN
38456-2136
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 931-999-2663
  • Fax: 931-820-9044
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6897
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: