Individual provider · Type 1 NPI

Brandon Justin Fazalare, MD

Student in an Organized Health Care Education/Training Program · Johnson City, TN

NPI number 1609565860 Active

Practice location

325 N State Of Franklin Rd Fl 3
Johnson City, TN 37604-6171

Call (423) 439-7201 Map

Fax (423) 439-7219

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1609565860

Brandon Justin Fazalare, MD's National Provider Identifier is 1609565860, issued on May 3, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Johnson City, TN. The record was last updated on May 3, 2023.