Provider Demographics
NPI:1225136104
Name:BRANTLEY, JULIAN C III (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:C
Last Name:BRANTLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GREEN ST E
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4105
Mailing Address - Country:US
Mailing Address - Phone:252-293-0013
Mailing Address - Fax:252-243-2576
Practice Address - Street 1:303 GREEN ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4105
Practice Address - Country:US
Practice Address - Phone:252-243-9800
Practice Address - Fax:252-243-9888
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21455207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17984OtherBLUE CROSS BLUE SHIELD
NC160030995OtherMEDICARE RAILROAD
NC8917984Medicaid
NC160030995OtherMEDICARE RAILROAD
NCC82948Medicare UPIN