=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790912574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY JEAN FAIRBROTHER BRANDON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2009
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1236 HUFFMAN MILL RD STE 1300
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-227-2761
-----------------------------------------------------
Fax | 336-585-0688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1236 HUFFMAN MILL RD STE 1300
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-227-2761
-----------------------------------------------------
Fax | 336-585-0688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 201500570
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------