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General NPI Number Information
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NPI Number | 1760673594
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Entity Type | Organization
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Legal Business Name | BRANDON CLINIC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 348 CROSSGATES BLVD SUITE 1200
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City | BRANDON
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State | MS
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Zip | 39042-2700
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Country | US
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Telephone | 601-824-3277
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Fax | 601-591-1202
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Provider Business Mailing Address
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Address Line | 348 CROSSGATES BLVD SUITE 1200
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City | BRANDON
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State | MS
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Zip | 39042-2700
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Country | US
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Telephone | 601-824-3277
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Fax | 601-591-1202
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | BRAD SINCLAIR
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Credential |
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Telephone | 601-936-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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