Provider Demographics
NPI:1629210216
Name:HARRIS, BRADY TYLER (MD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:TYLER
Last Name:HARRIS
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 1:2416 21ST AVE S STE 301
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5318
Mailing Address - Country:US
Mailing Address - Phone:615-499-4224
Mailing Address - Fax:615-499-5726
Practice Address - Street 1:2416 21ST AVE S STE 301
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5318
Practice Address - Country:US
Practice Address - Phone:615-499-4224
Practice Address - Fax:615-499-5736
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN539372086S0122X
KY46981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery