Healthcare Provider Details

I. General information

NPI: 1093678443
Provider Name (Legal Business Name): BRANDON PRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 ARABIA RD
LUMBER BRIDGE NC
28357-9659
US

IV. Provider business mailing address

8510 ARABIA RD
LUMBER BRIDGE NC
28357-9659
US

V. Phone/Fax

Practice location:
  • Phone: 910-263-0011
  • Fax: 910-263-0011
Mailing address:
  • Phone: 910-263-0011
  • Fax: 910-263-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number22234449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: