Provider Demographics
NPI:1134006372
Name:HAYGOOD, BRODY GRIFFIN
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:GRIFFIN
Last Name:HAYGOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NISBET ST NW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1292 COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:DUTTON
Practice Address - State:AL
Practice Address - Zip Code:35744-7635
Practice Address - Country:US
Practice Address - Phone:256-609-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program