Provider Demographics
NPI:1407892516
Name:CARLSON, BRIAN R (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:CARLSON
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 1:4733 ANDREW JACKSON PKWY
Mailing Address - Street 2:STE G1
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1358
Mailing Address - Country:US
Mailing Address - Phone:615-883-0527
Mailing Address - Fax:615-885-8356
Practice Address - Street 1:1411 W BADDOUR PARKWAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-443-2572
Practice Address - Fax:615-443-2516
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009382207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386167Medicare PIN
TN3401237Medicare PIN
3401237Medicare ID - Type Unspecified
B00198Medicare UPIN
3386167Medicare ID - Type Unspecified