Provider Demographics
NPI:1558540864
Name:BRANTLEY, HUTTON P (DO)
Entity Type:Individual
Prefix:
First Name:HUTTON
Middle Name:P
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:SUITE 707
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-780-4330
Mailing Address - Fax:205-780-7775
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:SUITE 707
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-780-4330
Practice Address - Fax:205-780-7775
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO956207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1558540864Medicaid