Provider Demographics
NPI:1073569489
Name:BROOKS, NATHANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1816
Mailing Address - Country:US
Mailing Address - Phone:731-989-2116
Mailing Address - Fax:731-989-7607
Practice Address - Street 1:208 NORTH AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1816
Practice Address - Country:US
Practice Address - Phone:731-989-2116
Practice Address - Fax:731-989-7607
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4129684OtherBCBS
TN4129684OtherBCBS
TNP00336925Medicare PIN
TN3084037Medicare PIN