Provider Demographics
NPI:1457344046
Name:SIKES, BRANDY W (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:W
Last Name:SIKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-537-4986
Mailing Address - Fax:912-526-4783
Practice Address - Street 1:110 R T STANLEY SR PL
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436
Practice Address - Country:US
Practice Address - Phone:912-526-9355
Practice Address - Fax:912-526-4783
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant