# BROOKSIDE MEDICAL CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083637078
- **Authorized official:** SHIRLEY SPEARS MS, ANP, BC (ADMINISTRATOR)
- **Authorized official phone:** (423) 238-0033

## Contact information

- **Practice address:** 5121 OOLTEWAH RINGGOLD ROAD, SUITE G, COLLEGEDALE, TN 37315
- **Practice address phone:** (423) 238-0033
- **Mailing address:** PO BOX 793, OOLTEWAH, TN 37363-0793
- **Mailing address phone:** (423) 238-0033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 11/30/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3735307 | — | TN |