Individual
BRANDON BENTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-5857
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME147385
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
95418
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108673700
—
FL
Enumeration date
06/10/2019
Last updated
07/18/2023
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