Healthcare Provider Details

I. General information

NPI: 1275766545
Provider Name (Legal Business Name): BRANDY LEIGH YARBROUGH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 DOCTORS DR
LAGRANGE GA
30240-4139
US

IV. Provider business mailing address

1551 DOCTORS DR
LAGRANGE GA
30240-4139
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-7450
  • Fax: 770-999-2818
Mailing address:
  • Phone: 706-803-7450
  • Fax: 770-999-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN129044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: