Provider Demographics
NPI:1760254635
Name:ERRICK, BRIAN MATTHEW
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MATTHEW
Last Name:ERRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 JOE D COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:TN
Mailing Address - Zip Code:38573-5616
Mailing Address - Country:US
Mailing Address - Phone:931-510-4889
Mailing Address - Fax:
Practice Address - Street 1:275 JOE D COFFEE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:TN
Practice Address - Zip Code:38573-5616
Practice Address - Country:US
Practice Address - Phone:931-510-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program