Provider Demographics
NPI:1184610248
Name:HEALTHSTAR PHYSICIANS, P.C.
Entity type:Organization
Organization Name:HEALTHSTAR PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ODESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRABSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-581-5925
Mailing Address - Street 1:420 W MORRIS BLVD STE 400A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2262
Mailing Address - Country:US
Mailing Address - Phone:423-581-5925
Mailing Address - Fax:423-581-2828
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:STE. 400A
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2283
Practice Address - Country:US
Practice Address - Phone:423-581-5925
Practice Address - Fax:423-581-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 17188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707888Medicaid
TN3707881Medicaid
TN3980158Medicaid
TN3980158Medicaid
TN3707881Medicare PIN
TN3707888Medicare PIN
TN3707888Medicaid