Healthcare Provider Details

I. General information

NPI: 1629210216
Provider Name (Legal Business Name): BRADY TYLER HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 21ST AVE S STE 301
NASHVILLE TN
37212-5318
US

IV. Provider business mailing address

2416 21ST AVE S STE 301
NASHVILLE TN
37212-5318
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-4224
  • Fax: 615-499-5736
Mailing address:
  • Phone: 615-499-4224
  • Fax: 615-499-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number53937
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46981
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: