Provider Demographics
NPI:1609873942
Name:BRADY, ROBIN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MICHAEL
Last Name:BRADY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-7308
Mailing Address - Country:US
Mailing Address - Phone:615-618-4910
Mailing Address - Fax:
Practice Address - Street 1:7268 JARNIGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3097
Practice Address - Country:US
Practice Address - Phone:423-508-7337
Practice Address - Fax:423-508-7338
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002084152W00000X
TNOD0000001640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6156Medicaid
TN3721447Medicaid
GA41CZFLDMedicaid
TN3946048Medicaid
TNMB0248220OtherDEA
TN3946048Medicare PIN
GAGRP6156Medicaid