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General NPI Number Information
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NPI Number | 1144890518
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Entity Type | Individual
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Provider Name | BRANDON ANDRE SADBERRY II
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Gender | Male
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 1901 PHOENIX BLVD STE 100
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5062
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Country | US
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Telephone | 678-619-5697
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Fax |
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Provider Business Mailing Address
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Address Line | 178 PARADISE DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5240
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Country | US
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Telephone | 404-840-5629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122382
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License Number State | GA
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