Organization
TKB MCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BRASWELL MD (OWNER)
(662) 226-2030
Entity
Organization
Contact information
Practice address
990 J K AVENT DR, GRENADA, MS 38901-5002
(662) 226-2030
(662) 227-1236
Mailing address
PO BOX 458, GRENADA, MS 38902-0458
(662) 226-2030
(662) 227-1236
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06207726
—
MS
Enumeration date
04/17/2007
Last updated
08/22/2020
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