Provider Demographics
NPI:1912027103
Name:INGRAM, BRANDON MARTEL
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:MARTEL
Last Name:INGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GRIGSBY LN
Mailing Address - Street 2:104
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4838
Mailing Address - Country:US
Mailing Address - Phone:901-756-5658
Mailing Address - Fax:
Practice Address - Street 1:185 GRIGSBY LN
Practice Address - Street 2:104
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4838
Practice Address - Country:US
Practice Address - Phone:901-756-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program