Provider Demographics
NPI:1144890518
Name:SADBERRY, BRANDON ANDRE II
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ANDRE
Last Name:SADBERRY
Suffix:II
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 1:178 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5240
Mailing Address - Country:US
Mailing Address - Phone:404-840-5629
Mailing Address - Fax:
Practice Address - Street 1:1901 PHOENIX BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5062
Practice Address - Country:US
Practice Address - Phone:678-619-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist