Provider Demographics
NPI:1164721130
Name:BROOKS, BYRON ANGELI JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:ANGELI
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:764 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2107
Mailing Address - Country:US
Mailing Address - Phone:478-633-1056
Mailing Address - Fax:478-749-9171
Practice Address - Street 1:764 PINE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-633-1056
Practice Address - Fax:478-749-9171
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA21687183500000X
GA390200000X
GA008721207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program