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General NPI Number Information
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NPI Number | 1780281527
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Entity Type | Organization
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Legal Business Name | BRAXTON MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 1410 KENSINGTON SQUARE CT STE 103
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City | MURFREESBORO
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State | TN
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Zip | 37130-6902
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Country | US
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Telephone | 615-900-1659
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Fax | 615-912-9997
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Provider Business Mailing Address
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Address Line | 1410 KENSINGTON SQUARE CT STE 103
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City | MURFREESBORO
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State | TN
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Zip | 37130-6902
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Country | US
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Telephone | 615-900-1659
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | JOHN GEORGE TSIBU
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Credential | NP-C
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Telephone | 615-900-1659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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