Provider Demographics
NPI:1841849031
Name:EVERETT, BRANDON JACOBY (RPSGT, CSE)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JACOBY
Last Name:EVERETT
Suffix:
Gender:M
Credentials:RPSGT, CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21060 SALLEY MCNAIR RD
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-7150
Mailing Address - Country:US
Mailing Address - Phone:910-544-9407
Mailing Address - Fax:
Practice Address - Street 1:610 N FAYETTEVILLE ST STE 302
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4671
Practice Address - Country:US
Practice Address - Phone:336-894-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18560246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty