Provider Demographics
NPI:1023778040
Name:BRANNER, CHRISTOPHER ALLEN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:BRANNER
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 1:1617 CRANFORD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6707
Mailing Address - Country:US
Mailing Address - Phone:615-481-3061
Mailing Address - Fax:
Practice Address - Street 1:1617 CRANFORD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6707
Practice Address - Country:US
Practice Address - Phone:615-481-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3979133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered