Brautigam, Darrell Lawrence
Brautigam, Darrell Lawrence is an individual health care provider with primary practice located at 7175 Jonesboro Rd , Morrow GA 30260-2943. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Brautigam, Darrell Lawrence can be contacted via phone (770) 961-2020.Contact Information
Primary practice address
7175 Jonesboro Rd
Morrow GA 30260-2943
Phone: (770) 961-2020
Fax: (770) 968-0854
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 683T | Georgia |
Profile Details
| NPI number | 1467454272 |
|---|---|
| LBN Legal business name | Brautigam, Darrell Lawrence |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2005 |
| Last updated | May 18th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467454272 | NPPES |
| Georgia | MEDICAID | 55000122A |
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