Basic Information
| Provider Information | |||||||||
| NPI: | 1336390863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLY | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 TVC | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153223000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1161 21ST AVE S | ||||||||
| Address2: | A-0118 MEDICAL CENTER NORTH | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158757378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 07/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 8906 | MA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | P2984 | TN | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.