Provider Demographics
NPI:1699895409
Name:ALT, BRANDI KAY (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:KAY
Last Name:ALT
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:124 VERDAE BLVD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-271-9780
Mailing Address - Fax:864-271-9785
Practice Address - Street 1:124 VERDAE BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-271-9780
Practice Address - Fax:864-271-9785
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL760207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare ID - Type Unspecified