Healthcare Provider Details

I. General information

NPI: 1346460367
Provider Name (Legal Business Name): BRANDON W SKELTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9321
US

IV. Provider business mailing address

PO BOX 2285
CORINTH MS
38835-2285
US

V. Phone/Fax

Practice location:
  • Phone: 662-821-1837
  • Fax: 662-680-5103
Mailing address:
  • Phone: 662-507-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116018271
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number46706
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21303
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101240781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: