Basic Information
| Provider Information | |||||||||
| NPI: | 1073086732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCPHAIL | ||||||||
| FirstName: | BRANDOLYN | ||||||||
| MiddleName: | JAVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746724 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | 7738668014 | ||||||||
| Practice Location | |||||||||
| Address1: | 6824 HARRISBURG RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282273389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048706014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2019 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P011093 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.