Basic Information
| Provider Information | |||||||||
| NPI: | 1245387109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | BRAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE VANTAGE WAY | ||||||||
| Address2: | ST B240 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153294020 | ||||||||
| FaxNumber: | 6153299479 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CHURCH STREET | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152848484 | ||||||||
| FaxNumber: | 6152843854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 41817 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.