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Individual

BRANDON DAVID SOUTHERN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004179A
IN

Other

Enumeration date
09/19/2019
Last updated
09/19/2019
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