Provider Demographics
NPI:1871754515
Name:GORRELL, BRANDIE HARDEN (DO)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:HARDEN
Last Name:GORRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 OAK BRANCH DR.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-8800
Mailing Address - Country:US
Mailing Address - Phone:540-239-0513
Mailing Address - Fax:
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-540-4155
Practice Address - Fax:931-540-4222
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2368208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist