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General NPI Number Information
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NPI Number | 1134489024
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Entity Type | Organization
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Legal Business Name | BRADEN FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 7701 CORRYTON RD
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City | CORRYTON
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State | TN
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Zip | 37721-2630
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Country | US
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Telephone | 865-247-6263
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Fax | 865-247-6418
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | CORRYTON
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State | TN
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Zip | 37721-0108
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Country | US
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Telephone | 865-247-6263
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Fax | 865-247-6418
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | JOE M BRADEN
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Credential | PA-C
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Telephone | 865-247-6263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD48081
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1510
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License Number State | TN
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