Healthcare Provider Details

I. General information

NPI: 1508611351
Provider Name (Legal Business Name): BRANDI LAWRENCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI LAWRENCE LEAK NP

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 103
GREENSBORO NC
27401-1035
US

IV. Provider business mailing address

350 N COX ST STE 6
ASHEBORO NC
27203-5514
US

V. Phone/Fax

Practice location:
  • Phone: 336-663-4900
  • Fax: 336-663-4920
Mailing address:
  • Phone: 336-629-2201
  • Fax: 336-629-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022095470
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: