Provider Demographics
NPI:1821014176
Name:PRICE, BRENDA BELAGA (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:BELAGA
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:CAROL
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:98 BURNHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2759
Mailing Address - Country:US
Mailing Address - Phone:601-664-0204
Mailing Address - Fax:601-664-0904
Practice Address - Street 1:98 BURNHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2759
Practice Address - Country:US
Practice Address - Phone:601-664-0204
Practice Address - Fax:601-664-0904
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS180872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01228052Medicaid
MS01228052Medicaid