Provider Demographics
NPI:1649856386
Name:BLACKWELL, BRANDON O'NEIL (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:O'NEIL
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-671-5343
Mailing Address - Fax:
Practice Address - Street 1:4235 S NEW HOPE RD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8453
Practice Address - Country:US
Practice Address - Phone:704-825-4750
Practice Address - Fax:704-825-6985
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2024-01571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine