Provider Demographics
NPI:1972587277
Name:PLANT, BRIAN H (PAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:H
Last Name:PLANT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6971
Mailing Address - Country:US
Mailing Address - Phone:423-431-2477
Mailing Address - Fax:423-431-2478
Practice Address - Street 1:410 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6971
Practice Address - Country:US
Practice Address - Phone:423-431-2477
Practice Address - Fax:423-431-2478
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522339Medicaid
NC1972587277Medicaid
VA1972587277Medicaid
TN4117242OtherBCBST
TN3664045Medicaid
3703862Medicare PIN
TN3709285Medicare UPIN
VA1972587277Medicaid
3703865Medicare PIN
TN3664045Medicaid
TN103I978460Medicare PIN