Healthcare Provider Details

I. General information

NPI: 1598865958
Provider Name (Legal Business Name): CHARLES BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 DEVONIA ST
HARRIMAN TN
37748-2009
US

IV. Provider business mailing address

12 CADILLAC DRIVE SUITE 150
BRENTWOOD TN
37027-5355
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-1323
  • Fax:
Mailing address:
  • Phone: 615-690-1941
  • Fax: 615-690-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number016587
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: