Provider Demographics
NPI:1285182030
Name:DYKES, BRANDY (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:DYKES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 JASON CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-8013
Mailing Address - Country:US
Mailing Address - Phone:229-300-6654
Mailing Address - Fax:
Practice Address - Street 1:2095 JASON CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-8013
Practice Address - Country:US
Practice Address - Phone:229-300-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor