Provider Demographics
NPI:1245324011
Name:BRANNON, NIKKI R (MD)
Entity type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:R
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-519-8104
Mailing Address - Fax:256-519-8327
Practice Address - Street 1:2205 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3617
Practice Address - Country:US
Practice Address - Phone:256-306-4002
Practice Address - Fax:256-306-4067
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL246842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009993960Medicaid
AL051523974OtherBLUE CROSS
ALH21017Medicare UPIN
AL000010230Medicare ID - Type Unspecified