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General NPI Number Information
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NPI Number | 1366855843
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Entity Type | Individual
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Provider Name | BRANDON SCOTT PRUETT M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | CCB 4TH FL 1720 2ND AVE SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35294-2050
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Country | US
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Telephone | 205-934-4108
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Fax | 205-975-8950
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Provider Business Mailing Address
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Address Line | CCB 4TH FL 1720 2ND AVE SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35294-2050
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Country | US
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Telephone | 205-934-4108
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Fax | 205-975-8950
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ACSC.36945
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.36945
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License Number State | AL
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