Individual
DR. BRENT DAVIS STATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1135 S WALNUT AVE, COOKEVILLE, TN 38501-5961
(931) 400-0808
(615) 735-0008
Mailing address
1135 S WALNUT AVE, COOKEVILLE, TN 38501-5961
(931) 400-0808
(931) 400-0809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45555
TN
207V00000X
Obstetrics & Gynecology Physician
45555
TN
208M00000X
Hospitalist Physician
45555
TN
Other
Enumeration date
04/07/2007
Last updated
04/06/2017
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