Provider Demographics
NPI:1912432139
Name:SLAUGHTER, BROOKE MARIE BOWMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MARIE BOWMAN
Last Name:SLAUGHTER
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 1:205 S MCCRARY ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1499
Mailing Address - Country:US
Mailing Address - Phone:615-410-5438
Mailing Address - Fax:
Practice Address - Street 1:205 S MCCRARY ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1499
Practice Address - Country:US
Practice Address - Phone:615-563-2891
Practice Address - Fax:615-563-4582
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN61371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program