MEDICARE: BRANDY FISHER MA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1730822982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY FISHER MA

Provider Business Mailing Address
First Line	:	1701 OLD TRENTON RD APT 1002
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-2313
Country	:	US
Telephone Number	:	304-904-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-548-3177
Fax Number	:

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	11/17/2022

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Directions to “ BRANDY FISHER MA” Practice Location

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