Healthcare Provider Details

I. General information

NPI: 1942556493
Provider Name (Legal Business Name): BROOKS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 CRESTMOOR RD
NASHVILLE TN
37215-2654
US

IV. Provider business mailing address

2120 CRESTMOOR RD
NASHVILLE TN
37215-2654
US

V. Phone/Fax

Practice location:
  • Phone: 615-934-9001
  • Fax:
Mailing address:
  • Phone: 615-934-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number15976
License Number StateTN

VIII. Authorized Official

Name: TERRY CUSTOMS
Title or Position: CEO
Credential:
Phone: 615-934-9001