Healthcare Provider Details

I. General information

NPI: 1154774297
Provider Name (Legal Business Name): KATHY BRAWNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GORDON COMMERCIAL DR STE A
LAGRANGE GA
30240-5754
US

IV. Provider business mailing address

122 GORDON COMMERCIAL DR STE A
LAGRANGE GA
30240-5754
US

V. Phone/Fax

Practice location:
  • Phone: 706-845-4045
  • Fax: 706-845-4367
Mailing address:
  • Phone: 706-845-4045
  • Fax: 706-845-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRN093037
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: