Provider Demographics
NPI:1174704993
Name:ADVANCED MEDICAL CONSULTANTS
Entity type:Organization
Organization Name:ADVANCED MEDICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-473-6900
Mailing Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-3909
Mailing Address - Country:US
Mailing Address - Phone:615-473-6900
Mailing Address - Fax:931-640-9835
Practice Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-3909
Practice Address - Country:US
Practice Address - Phone:615-473-6900
Practice Address - Fax:931-640-9835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9298208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4170921OtherBC-BS TN
TN4170922OtherBCBSTN
TN3370217Medicaid
TN36651441Medicaid
TN4170922OtherBCBSTN
TN3370217Medicaid