MEDICARE: NICHOLAS TILFORD BRASWELL IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	15204	AL
2	208800000X	Urology Physician	15204	AL

General Provider Information

NPI Number	:	1316942154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS TILFORD BRASWELL IV M.D.

Provider Business Mailing Address
First Line	:	1213 13TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4311
Country	:	US
Telephone Number	:	256-973-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 13TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4311
Country	:	US
Telephone Number	:	256-973-3700
Fax Number	:	256-973-3701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/22/2025

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