Healthcare Provider Details

I. General information

NPI: 1912921404
Provider Name (Legal Business Name): CORNELIA B BROWN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD
MURFREESBORO TN
37129-1237
US

IV. Provider business mailing address

4608 CYNTHIA LN
MURFREESBORO TN
37127-6419
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-6120
  • Fax: 615-867-5780
Mailing address:
  • Phone: 615-896-0426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0000000334
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: