Provider Demographics
NPI:1639550783
Name:LANDRUM, EMILY LOVE BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOVE BRANDON
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LOVE
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 HOSPITAL RD.
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-323-3162
Mailing Address - Fax:662-323-1711
Practice Address - Street 1:501 HOSPITAL RD.
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-3162
Practice Address - Fax:662-323-1711
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine