Healthcare Provider Details

I. General information

NPI: 1528220274
Provider Name (Legal Business Name): BRAXTON JORDAN FIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

PO BOX 2546
DALTON GA
30722-2546
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9729
  • Fax:
Mailing address:
  • Phone: 706-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number070381
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number70381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: