Provider Demographics
NPI:1558399089
Name:BRASFIELD, JIM CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:CARROLL
Last Name:BRASFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17016
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-7016
Mailing Address - Country:US
Mailing Address - Phone:423-844-6407
Mailing Address - Fax:423-793-7004
Practice Address - Street 1:320 BRISTOL BLVD W
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8765
Practice Address - Country:US
Practice Address - Phone:423-844-6407
Practice Address - Fax:423-793-7004
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9991207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3014517OtherUMWA
TN4005735OtherBLUECROSS & BLUE SHIELD
TN7817131OtherAETNA
VA006101208Medicaid
TN140007601OtherRAIL ROAD MEDICARE
TN361712500OtherDEPT OF LABOR
TNTN0101OtherJOHN DEERE
TN7817131OtherAETNA
VA006101208Medicaid
TN3044517Medicare PIN