Basic Information
| Provider Information | |||||||||
| NPI: | 1528319456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLARY | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | GREEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 PATTERSON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153420038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153420038 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2193 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.