Individual
DR. BRIAN DOUGLAS SIDDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
280 E WILLOW CREEK LN, MC RAE, GA 31055-5128
(478) 864-3448
(478) 864-1288
Mailing address
PO BOX 371, 2251 WEST ELM STREET, WRIGHTSVILLE, GA 31096-0371
(478) 864-3448
(478) 864-1288
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
023227
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23227
STATE LICENSE
GA
Enumeration date
08/22/2007
Last updated
10/29/2018
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