Provider Demographics
NPI:1962611616
Name:RUDOLPH BOLLING, BRANDI JANNESS (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:JANNESS
Last Name:RUDOLPH BOLLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4377
Mailing Address - Country:US
Mailing Address - Phone:205-302-9000
Mailing Address - Fax:
Practice Address - Street 1:1100 7TH AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4377
Practice Address - Country:US
Practice Address - Phone:205-302-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL309862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry