Individual
BRANDON O'NEIL BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4235 S NEW HOPE RD STE A, GASTONIA, NC 28056-8453
(704) 825-4750
(704) 825-6985
Mailing address
PO BOX 744786, ATLANTA, GA 30374-4786
(704) 671-5343
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2024-01571
NC
Other
Enumeration date
03/23/2021
Last updated
09/06/2024
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