Healthcare Provider Details

I. General information

NPI: 1083015531
Provider Name (Legal Business Name): BRENDA W. MCCURDY AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809A E 11TH AVE
CORDELE GA
31015-3422
US

IV. Provider business mailing address

PO BOX 1342
LAKE PARK GA
31636-1342
US

V. Phone/Fax

Practice location:
  • Phone: 229-276-2552
  • Fax:
Mailing address:
  • Phone: 229-300-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN225409
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN225409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: