Healthcare Provider Details

I. General information

NPI: 1134006372
Provider Name (Legal Business Name): BRODY GRIFFIN HAYGOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 COUNTY ROAD 123
DUTTON AL
35744-7635
US

IV. Provider business mailing address

351 NISBET ST NW
JACKSONVILLE AL
36265-1005
US

V. Phone/Fax

Practice location:
  • Phone: 256-609-6320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: