Provider Demographics
NPI:1336152230
Name:CHADWICK, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PINECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2239
Mailing Address - Country:US
Mailing Address - Phone:064-025-5097
Mailing Address - Fax:
Practice Address - Street 1:2125 PINECLIFF DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2239
Practice Address - Country:US
Practice Address - Phone:706-812-2229
Practice Address - Fax:706-882-6455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043575207V00000X, 207VG0400X
GA43575261QX0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine