Provider Demographics
NPI:1093707937
Name:BRANDES, JAN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:LEWIS
Last Name:BRANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-4680
Practice Address - Fax:615-284-4681
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-07-28
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TN022045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515488Medicaid
TN3075036Medicare PIN
TN1515488Medicaid
TN3714571Medicare PIN
TNF54573Medicare UPIN