Provider Demographics
NPI:1538991005
Name:DUCKWORTH, BRANDON LAMONT I
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LAMONT
Last Name:DUCKWORTH
Suffix:I
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 1:711 NOAH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3759
Mailing Address - Country:US
Mailing Address - Phone:330-715-7294
Mailing Address - Fax:
Practice Address - Street 1:870 BIRUTA ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1147
Practice Address - Country:US
Practice Address - Phone:330-715-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty