Provider Demographics
NPI:1205621224
Name:SMITH, BRANDON A JR
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:A
Last Name:SMITH
Suffix:JR
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 1:3293 KRISTIN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3106
Mailing Address - Country:US
Mailing Address - Phone:614-400-3404
Mailing Address - Fax:
Practice Address - Street 1:1911 OAKLAND PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3630
Practice Address - Country:US
Practice Address - Phone:611-400-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator