Provider Demographics
NPI:1225136104
Name:BRANTLEY, JULIAN C III (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:C
Last Name:BRANTLEY
Suffix:III
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 1:132 FOY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-443-6622
Mailing Address - Fax:252-443-6404
Practice Address - Street 1:132 FOY DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-443-6622
Practice Address - Fax:252-443-6404
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21455208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160030995OtherMEDICARE RAILROAD
NC17984OtherBLUE CROSS BLUE SHIELD
NC8917984Medicaid
NC160030995OtherMEDICARE RAILROAD
NCC82948Medicare UPIN