Provider Demographics
NPI:1043326176
Name:BREWINGTON, STACY DAVID (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:DAVID
Last Name:BREWINGTON
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 1:228 WEST 4TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-372-0405
Mailing Address - Fax:931-372-0463
Practice Address - Street 1:228 W. 4TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-372-0405
Practice Address - Fax:931-372-0463
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30775207RI0011X
TN30775207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3836719Medicaid
TN4288870OtherBCBS
KY7100015180Medicaid
TN4288870OtherBCBS
G97776Medicare UPIN