Provider Demographics
NPI:1164675427
Name:DAMON BRANTLEY MD PC
Entity Type:Organization
Organization Name:DAMON BRANTLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-358-4833
Mailing Address - Street 1:237 GRAY HAWK TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6286
Mailing Address - Country:US
Mailing Address - Phone:931-358-4833
Mailing Address - Fax:931-358-3460
Practice Address - Street 1:4810 WHITESPORT CIR SW
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7419
Practice Address - Country:US
Practice Address - Phone:931-358-4833
Practice Address - Fax:931-358-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty