Provider Demographics
NPI:1982669842
Name:BRANNON, CAROLYN C (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:C
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1039 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7900
Practice Address - Country:US
Practice Address - Phone:423-874-0125
Practice Address - Fax:423-874-0154
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3875832Medicare ID - Type Unspecified
C50693Medicare UPIN