Provider Demographics
NPI:1306660204
Name:DEVERICKS, BRANDI BEAU (CLD)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:BEAU
Last Name:DEVERICKS
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 SUMMER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5865
Mailing Address - Country:US
Mailing Address - Phone:949-600-3239
Mailing Address - Fax:
Practice Address - Street 1:3215 SUMMER VIEW DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5865
Practice Address - Country:US
Practice Address - Phone:949-600-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty