Individual
DR. TERRI R BRUNVOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1025 EXECUTIVE DR, SUITE 100, HIXSON, TN 37343-7916
(423) 870-2030
(423) 875-6405
Mailing address
1025 EXECUTIVE DR, SUITE 100, HIXSON, TN 37343-7916
(423) 870-2030
(423) 875-6405
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
207Q00000X
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080157953
MEDICARE RR
TN
05
—
5064580
—
TN
01
—
DO0000001148
MEDICAL LICENSE
TN
Enumeration date
03/12/2007
Last updated
03/22/2011
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