Provider Demographics
NPI:1144413956
Name:SANSING, BROCKTON JOLLY (MD)
Entity Type:Individual
Prefix:
First Name:BROCKTON
Middle Name:JOLLY
Last Name:SANSING
Suffix:
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 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-222-6977
Mailing Address - Fax:615-222-5322
Practice Address - Street 1:4220 HARDING PIKE
Practice Address - Street 2:SUITE 500
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COA97656207RG0300X
TN49166208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100228510Medicaid
TN1530522Medicaid
TN4340915OtherBLUECROSS BLUESHIELD
KY7100228510Medicaid
P01173760Medicare PIN