Provider Demographics
NPI:1740419746
Name:BROOKS, PEGGY SUE (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:SUE
Other - Last Name:CAVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4513 HIXSON PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5039
Mailing Address - Country:US
Mailing Address - Phone:423-877-7999
Mailing Address - Fax:423-877-7901
Practice Address - Street 1:4513 HIXSON PIKE STE 102
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5039
Practice Address - Country:US
Practice Address - Phone:423-877-7999
Practice Address - Fax:423-877-7901
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48253207Q00000X
VA0101258407207Q00000X
TN48253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528940Medicaid
VA1740419746Medicaid
NC1740419746Medicaid
TN103I083041Medicare PIN