Provider Demographics
NPI:1134489024
Name:BRADEN FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:BRADEN FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:865-247-6263
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-0108
Mailing Address - Country:US
Mailing Address - Phone:865-247-6263
Mailing Address - Fax:865-247-6418
Practice Address - Street 1:7701 CORRYTON RD
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-2630
Practice Address - Country:US
Practice Address - Phone:865-247-6263
Practice Address - Fax:865-247-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48081207Q00000X
TNPA1510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty