Healthcare Provider Details

I. General information

NPI: 1558129205
Provider Name (Legal Business Name): DAVID PAUL HARRISON BRANDT NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

IV. Provider business mailing address

4548 BLAIRMONT DR SE
OWENS CROSS ROADS AL
35763-8014
US

V. Phone/Fax

Practice location:
  • Phone: 205-421-2088
  • Fax: 205-278-7660
Mailing address:
  • Phone: 256-651-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-129068
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: