Provider Demographics
NPI:1790148203
Name:MIZE, BRANDY COLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:COLLEEN
Last Name:MIZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:MIZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1901 PERDIDO ST STE 3205
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 18TH ST STE A30
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1535
Practice Address - Country:US
Practice Address - Phone:706-571-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312403207R00000X, 207RC0200X, 207RP1001X
390200000X
GA92725207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program