Healthcare Provider Details

I. General information

NPI: 1609175272
Provider Name (Legal Business Name): BRANDON-LUKE LABRON SEAGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLANTATION RIDGE DR
AMERICUS GA
31709-5283
US

IV. Provider business mailing address

100 PLANTATION RIDGE DR
AMERICUS GA
31709-5283
US

V. Phone/Fax

Practice location:
  • Phone: 229-474-6933
  • Fax:
Mailing address:
  • Phone: 229-474-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number081091
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: