Provider Demographics
NPI:1265047633
Name:DUGGINS, ANDREW BRANDON (NCLMBT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRANDON
Last Name:DUGGINS
Suffix:
Gender:M
Credentials:NCLMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 YARBROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-1642
Mailing Address - Country:US
Mailing Address - Phone:336-618-4036
Mailing Address - Fax:
Practice Address - Street 1:4020 YARBROUGH AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-1642
Practice Address - Country:US
Practice Address - Phone:336-618-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist