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General NPI Number Information
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NPI Number | 1245387109
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Entity Type | Individual
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Provider Name | BRAD RUSSELL MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 2000 CHURCH STREET EMERGENCY DEPT
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City | NASHVILLE
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State | TN
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Zip | 37236
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Country | US
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Telephone | 615-284-8484
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Fax | 615-284-3854
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Provider Business Mailing Address
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Address Line | ONE VANTAGE WAY ST B240
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City | NASHVILLE
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State | TN
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Zip | 37228
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Country | US
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Telephone | 615-329-4020
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Fax | 615-329-9479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 41817
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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