Provider Demographics
NPI:1881756716
Name:FLOYD, BRANDY SMITH (PA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:SMITH
Last Name:FLOYD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-3385
Mailing Address - Fax:229-758-5198
Practice Address - Street 1:103 RE JENNINGS AVE SE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-8725
Practice Address - Country:US
Practice Address - Phone:229-725-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004224363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ10382Medicare UPIN