Healthcare Provider Details

I. General information

NPI: 1316248115
Provider Name (Legal Business Name): ANTRINA DENISE BRANTLEY LANDRY RN, MSN, PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTRINA DENISE BRANTLEY RN, MSN, PNP-AC

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2555
  • Fax:
Mailing address:
  • Phone: 404-785-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19994
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number288454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: