Provider Demographics
NPI:1316942154
Name:BRASWELL, NICHOLAS TILFORD IV (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TILFORD
Last Name:BRASWELL
Suffix:IV
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 1:1848 PARKLAND DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058
Mailing Address - Country:US
Mailing Address - Phone:256-739-2885
Mailing Address - Fax:256-739-2898
Practice Address - Street 1:1213 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4311
Practice Address - Country:US
Practice Address - Phone:256-973-3700
Practice Address - Fax:256-973-3701
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009915890Medicaid
AL19-10011OtherUNITED HEALTHCARE PROVIDE
AL3178568-001OtherCIGNA PROVIDER
AL009908125Medicaid
AL009915740Medicaid
AL051511975OtherBC-BS OF ALABAMA PROVIDER
AL051046750OtherBC-BS OF ALABAMA PROVIDER
AL009915900Medicaid
AL051046785OtherBC-BS OF ALABAMA PROVIDER
AL051046738OtherBC-BS OF ALABAMA PROVIDER
AL051046738OtherBC-BS OF ALABAMA PROVIDER
AL051046750OtherBC-BS OF ALABAMA PROVIDER
AL3178568-001OtherCIGNA PROVIDER
AL009915900Medicaid
AL051046785OtherBC-BS OF ALABAMA PROVIDER