Provider Demographics
NPI:1801785928
Name:WILLIAMS, BRANDY NICOLE (LDO)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:X
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 US HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 US HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8164
Practice Address - Country:US
Practice Address - Phone:229-387-8863
Practice Address - Fax:229-387-9261
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO003082156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician