MEDICARE: DORIS BRAZELL FAIR

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
1	376K00000X	Nurse's Aide	CN0000047248	GA

General Provider Information

NPI Number	:	1679149991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS BRAZELL FAIR

Provider Business Mailing Address
First Line	:	2002 CODY LN APT 23
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-7955
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 CODY LN APT 23
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-7955
Country	:	US
Telephone Number	:	912-481-6251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “ DORIS BRAZELL FAIR ” Practice Location

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