Basic Information
| Provider Information | |||||||||
| NPI: | 1104116326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABCOCK | ||||||||
| FirstName: | BRANDON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234336039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16000 JOHNSTON MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762581000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 64087 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 64087 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 0101258439 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 64087 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 0101258439 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | 0101258439 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.