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NPI Code Detail

MEDICARE: BRANDI N BOLT

MEDICARE: BRANDI N BOLT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB1544517GA

General Provider Information

NPI Number : 1174465363
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI N BOLT
Provider Business Mailing Address
First Line : 3633 WHEELER RD STE 320
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6552
Country : US
Telephone Number : 706-817-4149
Fax Number :
Provider Business Practice Location Address
First Line : 3633 WHEELER RD STE 320
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6552
Country : US
Telephone Number : 706-817-4149
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ BRANDI N BOLT ” Practice Location

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