Provider Demographics
NPI:1356307946
Name:BRASWELL, THOMAS KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:BRASWELL
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 1:990 AVENT DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5002
Mailing Address - Country:US
Mailing Address - Phone:662-226-2030
Mailing Address - Fax:662-227-1236
Practice Address - Street 1:990 AVENT DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5002
Practice Address - Country:US
Practice Address - Phone:662-226-2030
Practice Address - Fax:662-227-1236
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13510207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112536Medicaid
MS180000296Medicare PIN
MSF58539Medicare UPIN
MS5445380001Medicare NSC