Provider Demographics
NPI:1194450544
Name:ELAM, BRANDY
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:ELAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 BARTOW WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-3826
Mailing Address - Country:US
Mailing Address - Phone:762-207-4976
Mailing Address - Fax:
Practice Address - Street 1:6851 BARTOW WAY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-3826
Practice Address - Country:US
Practice Address - Phone:762-207-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor