Provider Demographics
NPI:1457404170
Name:AUGUSTINE, BRANDY CARROLL (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:CARROLL
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3427 RIVER HEIGHTS XING SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4892
Mailing Address - Country:US
Mailing Address - Phone:678-654-6440
Mailing Address - Fax:
Practice Address - Street 1:895 CANTON RD NE
Practice Address - Street 2:#100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8934
Practice Address - Country:US
Practice Address - Phone:770-427-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist