Provider Demographics
NPI:1124204813
Name:FLOOD, BRANDY HOBBS
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:HOBBS
Last Name:FLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1250
Mailing Address - Country:US
Mailing Address - Phone:706-546-9290
Mailing Address - Fax:706-546-4938
Practice Address - Street 1:12877 JONES ST STE A
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1828
Practice Address - Country:US
Practice Address - Phone:706-546-9290
Practice Address - Fax:706-356-0579
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002405152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129184Medicaid
GA170245189AMedicaid
GA202I417479OtherHUMANA
GA202I417479OtherRR MEDICARE