Provider Demographics
NPI:1043895568
Name:BROOKS, KEANTHONY DARNELL
Entity type:Individual
Prefix:
First Name:KEANTHONY
Middle Name:DARNELL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HICKORY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-2396
Mailing Address - Country:US
Mailing Address - Phone:229-514-8752
Mailing Address - Fax:
Practice Address - Street 1:31 HICKORY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-2396
Practice Address - Country:US
Practice Address - Phone:229-514-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management