Provider Demographics
NPI:1215321450
Name:DAVIS, BRANDI RAE (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:RAE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SPRING HILL AVE
Mailing Address - Street 2:SUITE 3414
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1414
Mailing Address - Country:US
Mailing Address - Phone:251-434-3475
Mailing Address - Fax:
Practice Address - Street 1:1600 SPRING HILL AVE
Practice Address - Street 2:SUITE 3414
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1414
Practice Address - Country:US
Practice Address - Phone:251-434-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA81377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program