Provider Demographics
NPI:1871680900
Name:BREEDEN, GERALD EMERSON (PA)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:EMERSON
Last Name:BREEDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 409879
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9879
Mailing Address - Country:US
Mailing Address - Phone:615-261-6000
Mailing Address - Fax:615-261-6052
Practice Address - Street 1:2801 CHARLOTTE AVE.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209
Practice Address - Country:US
Practice Address - Phone:615-250-9200
Practice Address - Fax:615-250-9251
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA01018363A00000X
TNPA0000001018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13826Medicare UPIN