Provider Demographics
NPI:1548281298
Name:AUSTIN, BRETT L (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3125
Mailing Address - Country:US
Mailing Address - Phone:423-648-2395
Mailing Address - Fax:423-648-7542
Practice Address - Street 1:1604 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3125
Practice Address - Country:US
Practice Address - Phone:423-893-7226
Practice Address - Fax:423-893-7398
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0264412085R0202X
TNMD236872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3070323Medicaid
GA966200OtherBCBS OF GA
GA000714656Medicaid
TN3028284OtherBCBS OF TN
TN4072958OtherBCBS OF TN
GA595156OtherBCBS OF GA
TNP00048430Medicare PIN
GA000714656Medicaid
GAP00103235Medicare PIN
TN3028284OtherBCBS OF TN
GA966200OtherBCBS OF GA
TN3070323Medicaid
GA30BDLFVMedicare PIN
TN3070324Medicare PIN
GA300063946Medicare PIN