Provider Demographics
NPI:1841893252
Name:HOWARD, BRANDON D
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:D
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 CARPENTER RD N
Mailing Address - Street 2:
Mailing Address - City:CHULA
Mailing Address - State:GA
Mailing Address - Zip Code:31733-4111
Mailing Address - Country:US
Mailing Address - Phone:229-520-2515
Mailing Address - Fax:
Practice Address - Street 1:1092 CARPENTER RD N
Practice Address - Street 2:
Practice Address - City:CHULA
Practice Address - State:GA
Practice Address - Zip Code:31733-4111
Practice Address - Country:US
Practice Address - Phone:229-520-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor