Healthcare Provider Details

I. General information

NPI: 1346257821
Provider Name (Legal Business Name): CHARLES HAL BRUNT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 BRUNSWICK RD
MEMPHIS TN
38133
US

IV. Provider business mailing address

PO BOX 1000 DEPT 0510
MEMPHIS TN
38133-0510
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0338
  • Fax: 901-507-8298
Mailing address:
  • Phone: 901-821-0338
  • Fax: 901-821-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number009454
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: