Provider Demographics
NPI:1841657665
Name:BROTHERS, CORLEY (PA-C)
Entity type:Individual
Prefix:
First Name:CORLEY
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4239
Mailing Address - Country:US
Mailing Address - Phone:615-818-9888
Mailing Address - Fax:615-891-5021
Practice Address - Street 1:5073 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2737
Practice Address - Country:US
Practice Address - Phone:615-302-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2924363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020247Medicaid
TNQ020247Medicaid