Provider Demographics
NPI:1225479520
Name:SMITH, BRANDON WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WAYNE
Last Name:SMITH
Suffix:
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 1:300 E WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1229
Mailing Address - Country:US
Mailing Address - Phone:336-663-5220
Mailing Address - Fax:
Practice Address - Street 1:1248 HUFFMAN MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-890-3390
Practice Address - Fax:336-890-3391
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4301102913174400000X
MN67097207T00000X
NC202101178207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist