Healthcare Provider Details

I. General information

NPI: 1528583853
Provider Name (Legal Business Name): BRENDA JOYCE HANSFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD STE 300
ATLANTA GA
30337-5600
US

IV. Provider business mailing address

4751 BEST RD STE 300
ATLANTA GA
30337-5600
US

V. Phone/Fax

Practice location:
  • Phone: 804-510-0811
  • Fax:
Mailing address:
  • Phone: 804-510-0811
  • Fax: 804-716-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: