Healthcare Provider Details

I. General information

NPI: 1205953908
Provider Name (Legal Business Name): BRENT MATTHEW MAY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 DAWKINS DR
LEWISBURG WV
24901-9302
US

IV. Provider business mailing address

2000 HEALTH PARK DR FL HP2
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-0870
  • Fax: 304-645-0970
Mailing address:
  • Phone: 615-373-7600
  • Fax: 877-767-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberWV461
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001962
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: