Healthcare Provider Details

I. General information

NPI: 1144413956
Provider Name (Legal Business Name): BROCKTON JOLLY SANSING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING PIKE SUITE 500
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

501 GREAT CIRCLE RD SUITE 200
NASHVILLE TN
37228-1317
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-6977
  • Fax:
Mailing address:
  • Phone: 615-222-6977
  • Fax: 615-222-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA97656
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49166
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: