Provider Demographics
NPI:1598865958
Name:BROOKS, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BROOKS
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 1:12 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5355
Mailing Address - Country:US
Mailing Address - Phone:615-690-1941
Mailing Address - Fax:615-690-3941
Practice Address - Street 1:412 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2009
Practice Address - Country:US
Practice Address - Phone:865-882-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN016587207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3842503Medicaid
TNP00255506OtherRAILROAD MEDICARE
TN3094186OtherBCBS OF TENNESSEE
TN3842503Medicaid
TN3842503Medicare PIN