Provider Demographics
NPI:1477091486
Name:PREMIER MEDICAL CONSULTANTS,LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIBRAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NADDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-384-9706
Mailing Address - Street 1:1707 GROVE DRIVE
Mailing Address - Street 2:ATTN. KATHLEEN BROWNING
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6018
Mailing Address - Country:US
Mailing Address - Phone:931-384-9706
Mailing Address - Fax:931-384-9706
Practice Address - Street 1:1707 GROVE DRIVE
Practice Address - Street 2:ATTN. KATHLEEN BROWNING
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3840
Practice Address - Country:US
Practice Address - Phone:615-309-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035351Medicaid
TNQ035351Medicaid