Provider Demographics
NPI:1033409438
Name:FULLER, BRIAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6140
Mailing Address - Country:US
Mailing Address - Phone:615-327-4877
Mailing Address - Fax:
Practice Address - Street 1:6107 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:NUNNELLY
Practice Address - State:TN
Practice Address - Zip Code:37137-2523
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD519602084P0800X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine