Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003299835 |
---|---|
Provider Name | Brandon Haygood |
First Address | Decatur, GA 30033 |
Second Address | Decatur, GA 30033-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 29/06/2015 |