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General NPI Number Information
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NPI Number | 1164675427
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Entity Type | Organization
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Legal Business Name | DAMON BRANTLEY MD PC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 4810 WHITESPORT CIR SW SUITE 200
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City | HUNTSVILLE
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State | AL
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Zip | 35801-7419
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Country | US
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Telephone | 931-358-4833
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Fax | 931-358-3460
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Provider Business Mailing Address
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Address Line | 237 GRAY HAWK TRL
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6286
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Country | US
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Telephone | 931-358-4833
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Fax | 931-358-3460
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Authorized Official
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Title or Position | OWNER
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Name | DAMON W BRANTLEY
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Credential | MD
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Telephone | 931-358-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22207
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License Number State | AL
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