Healthcare Provider Details

I. General information

NPI: 1790148203
Provider Name (Legal Business Name): BRANDY COLLEEN MIZE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDY MIZE MD

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 18TH ST STE A30
COLUMBUS GA
31901-1535
US

IV. Provider business mailing address

1901 PERDIDO ST STE 3205
NEW ORLEANS LA
70112-1393
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number312403
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number312403
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number312403
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number92725
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: