Provider Demographics
NPI:1023019429
Name:CHASTAIN, BRYAN DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DEE
Last Name:CHASTAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:155 HEALTH WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2658
Mailing Address - Country:US
Mailing Address - Phone:931-473-5394
Mailing Address - Fax:931-473-6636
Practice Address - Street 1:155 HEALTH WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2658
Practice Address - Country:US
Practice Address - Phone:931-473-5394
Practice Address - Fax:931-473-6636
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000018822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3844940Medicaid
TN3844940Medicaid
TNA99670Medicare UPIN