Provider Demographics
NPI:1932891587
Name:HARDY, BRANDON P
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:P
Last Name:HARDY
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 1:307 POWDER HORN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-7043
Mailing Address - Country:US
Mailing Address - Phone:251-406-2204
Mailing Address - Fax:
Practice Address - Street 1:307 POWDER HORN DR
Practice Address - Street 2:
Practice Address - City:MIDLAND CITY
Practice Address - State:AL
Practice Address - Zip Code:36350-7043
Practice Address - Country:US
Practice Address - Phone:251-406-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program