Provider Demographics
NPI:1497221014
Name:MAGEE, BRANDUS (BS)
Entity Type:Individual
Prefix:
First Name:BRANDUS
Middle Name:
Last Name:MAGEE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5589
Mailing Address - Country:US
Mailing Address - Phone:985-707-1410
Mailing Address - Fax:985-707-1415
Practice Address - Street 1:350 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5589
Practice Address - Country:US
Practice Address - Phone:985-707-1410
Practice Address - Fax:985-707-1415
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1497221074Medicaid