Healthcare Provider Details

I. General information

NPI: 1356646434
Provider Name (Legal Business Name): BRETT L FERRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLIAM N. BLVD
TULLAHOMA TN
37388-4754
US

IV. Provider business mailing address

100 WILLIAM N. BLVD
TULLAHOMA TN
37388-4754
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-0489
  • Fax: 931-454-2348
Mailing address:
  • Phone: 931-454-0489
  • Fax: 931-454-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME107156
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD47136
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: