Healthcare Provider Details

I. General information

NPI: 1245387109
Provider Name (Legal Business Name): BRAD RUSSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CHURCH STREET EMERGENCY DEPT
NASHVILLE TN
37236
US

IV. Provider business mailing address

ONE VANTAGE WAY ST B240
NASHVILLE TN
37228
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-8484
  • Fax: 615-284-3854
Mailing address:
  • Phone: 615-329-4020
  • Fax: 615-329-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41817
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: