Provider Demographics
NPI:1144050147
Name:BRADY, MARK A
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E UNIVERSITY ST LOT B
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1555
Mailing Address - Country:US
Mailing Address - Phone:931-349-5863
Mailing Address - Fax:
Practice Address - Street 1:100 E UNIVERSITY ST LOT B
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1555
Practice Address - Country:US
Practice Address - Phone:931-349-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle