Healthcare Provider Details

I. General information

NPI: 1902853161
Provider Name (Legal Business Name): MILLICENT ANNE BRANCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD
MURFREESBORO TN
37129-1237
US

IV. Provider business mailing address

3400 LEBANON RD
MURFREESBORO TN
37129-1237
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-6000
  • Fax: 615-867-5791
Mailing address:
  • Phone: 615-867-6000
  • Fax: 615-867-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number29788
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29788
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: