Provider Demographics
NPI:1033801949
Name:AHMAD, BRIANNA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BLAKESMOOR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5186
Mailing Address - Country:US
Mailing Address - Phone:803-351-2495
Mailing Address - Fax:
Practice Address - Street 1:6615 TWO NOTCH RD # B-1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7561
Practice Address - Country:US
Practice Address - Phone:803-351-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management