Healthcare Provider Details

I. General information

NPI: 1073569489
Provider Name (Legal Business Name): NATHANIEL BROOKS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NORTH AVE
HENDERSON TN
38340-1816
US

IV. Provider business mailing address

208 NORTH AVE
HENDERSON TN
38340-1816
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-2116
  • Fax: 731-989-7607
Mailing address:
  • Phone: 731-989-2116
  • Fax: 731-989-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25651
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: