Provider Demographics
NPI:1184908725
Name:MCCRERY, BRIAN WILLIAM (RD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:MCCRERY
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NW BROAD ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2776
Mailing Address - Country:US
Mailing Address - Phone:615-217-9473
Mailing Address - Fax:615-217-0660
Practice Address - Street 1:810 NW BROAD ST
Practice Address - Street 2:SUITE 234
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2776
Practice Address - Country:US
Practice Address - Phone:615-217-9473
Practice Address - Fax:615-217-0660
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN2398133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist