Provider Demographics
NPI:1487110771
Name:GOLDSON, BRANDY KELLAM
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:KELLAM
Last Name:GOLDSON
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 1:600 N. ASHLEY DRIVE
Mailing Address - Street 2:SUITE 1100-93609
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:904-504-9669
Mailing Address - Fax:904-491-2187
Practice Address - Street 1:600 N ASHLEY DRIVE
Practice Address - Street 2:SUITE 1100-93609
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5300
Practice Address - Country:US
Practice Address - Phone:904-504-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management