Healthcare Provider Details

I. General information

NPI: 1033119128
Provider Name (Legal Business Name): ROBERT L BRAND III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 J DEWEY GRAY CR
AUGUSTA GA
30909
US

IV. Provider business mailing address

PO BOX 14039
AUGUSTA GA
30919-0039
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9797
  • Fax: 706-860-7686
Mailing address:
  • Phone: 706-863-9797
  • Fax: 706-860-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: