Individual
BRAD A FELTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 N STATE OF FRANKLIN RD FL 3, JOHNSON CITY, TN 37604-6171
(423) 439-7201
(423) 438-7219
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-7201
(423) 439-7219
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
40928
MN
2086S0120X
Pediatric Surgery Physician
Primary
MD60987
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108781900
—
MN
05
—
Q057730
—
TN
Enumeration date
03/31/2006
Last updated
03/06/2024
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