Provider Demographics
NPI:1497720759
Name:BRODY, KIRK WARREN (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:WARREN
Last Name:BRODY
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 1:2341 MCCALLIE AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3227
Mailing Address - Country:US
Mailing Address - Phone:423-602-9674
Mailing Address - Fax:423-602-9690
Practice Address - Street 1:2341 MCCALLIE AVE PLAZA 3
Practice Address - Street 2:SUITE 403
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3239
Practice Address - Country:US
Practice Address - Phone:423-602-9764
Practice Address - Fax:423-602-9690
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29154OtherTN MEDICAL LICENSE #
TN3812288Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TNF94460Medicare UPIN