Healthcare Provider Details

I. General information

NPI: 1538526660
Provider Name (Legal Business Name): ROBERT BRILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 GA-515
JASPER GA
30143
US

IV. Provider business mailing address

101 EDGEWATER TRL
CANTON GA
30115-1812
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-2441
  • Fax:
Mailing address:
  • Phone: 912-536-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN201526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: