Provider Demographics
NPI:1205869724
Name:BRANDY DAVIS MD P A
Entity type:Organization
Organization Name:BRANDY DAVIS MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-494-4000
Mailing Address - Street 1:904 HOLIDAY DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-9183
Mailing Address - Country:US
Mailing Address - Phone:870-494-4000
Mailing Address - Fax:870-494-4033
Practice Address - Street 1:904 HOLIDAY DR
Practice Address - Street 2:SUITE 406
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-9183
Practice Address - Country:US
Practice Address - Phone:870-494-4000
Practice Address - Fax:870-494-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTRICARE
AR5F233Medicare ID - Type Unspecified
DD5783Medicare ID - Type UnspecifiedRAILROAD MEDICARE