Nathaniel Brooks Jr., MD
Individual provider Active NPI Family Medicine Physician · Henderson, TN
NPI 1073569489 · NPPES record last updated Jan 22, 2008
Key facts
- NPI
- 1073569489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 25651 (TN)
- Practice address
- 208 North Ave
Henderson, TN 38340-1816 - Phone
- (731) 989-2116
- Fax
- (731) 989-7607
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130701000752 | TN | Order and Referring Only - Family Practice |
2567473705 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25651 | TN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Clinic PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 25651 | TN | Yes |
Addresses
Primary practice location
208 North Ave
Henderson, TN 38340-1816
Mailing address
208 North Ave
Henderson, TN 38340-1816
Phone (731) 989-2116
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4129684 | Other | TN | BCBS |
Other providers in Henderson, TN
- Janice Doreen Beshires
- Joshua Colt Blankenship
- L. W. Bloomingburg
- Nicole Breeding
- Tequila Bridges
- Jodi Marie Brown
- Teresa Hea Brown
- Ashley Girlene Burke
- Rondall Scott Burns
- Rachael Canady
All providers in Henderson, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.