Basic Information
| Provider Information | |||||||||
| NPI: | 1174917744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | NICHOLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2195 HARRODSBURG RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236712 | ||||||||
| FaxNumber: | 8592577231 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 CARLTON STREET UNIVERSITY HEALTH CENTER | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306020001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065428587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2015 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | 51295 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207RS0010X | 84383 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.