Provider Demographics
NPI:1346847217
Name:TATE, BRANDON JONES
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JONES
Last Name:TATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CHERRY ST E
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-1130
Mailing Address - Country:US
Mailing Address - Phone:330-606-8855
Mailing Address - Fax:
Practice Address - Street 1:4161 BRIDGEWATER PKWY
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6191
Practice Address - Country:US
Practice Address - Phone:330-865-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator