Provider Demographics
NPI:1033252820
Name:NUNN, MARVIN BRADLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:BRADLEY
Last Name:NUNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:CULLEOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38451-2733
Mailing Address - Country:US
Mailing Address - Phone:931-987-0036
Mailing Address - Fax:
Practice Address - Street 1:1101 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2650
Practice Address - Country:US
Practice Address - Phone:615-463-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical