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General NPI Number Information
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NPI Number | 1487600896
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Entity Type | Individual
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Provider Name | BRIAN L HAVERDINK NP
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2258 WRIGHTSBORO RD STE 400
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City | AUGUSTA
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State | GA
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Zip | 30904-4788
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Country | US
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Telephone | 706-724-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 742 WILLIAM AVE
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City | APPLING
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State | GA
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Zip | 30802-1819
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN330264
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | RN330264
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License Number State | GA
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