Individual
DR. BRADLEY KEITH BROYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
960 E 3RD ST, SUITE 104, CHATTANOOGA, TN 37403
(865) 778-7628
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
39049
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390491
—
SC
01
—
SC85638510
MEDICARE PIN
SC
01
—
SC85639068
MEDICARE PIN
SC
Enumeration date
04/03/2013
Last updated
12/08/2020
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