Provider Demographics
NPI:1326101619
Name:BRANTLEY, BARRETT DUANE (MD)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:DUANE
Last Name:BRANTLEY
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 1:2010 CHURCH STREET
Mailing Address - Street 2:SUITE 615
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-284-7950
Mailing Address - Fax:615-284-5750
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0001
Practice Address - Country:US
Practice Address - Phone:615-284-5229
Practice Address - Fax:615-284-4373
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16867207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509865Medicaid
TN3043344Medicare PIN
TND93177Medicare UPIN