Healthcare Provider Details

I. General information

NPI: 1659857662
Provider Name (Legal Business Name): ROBERT ASHLEY BRUNSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINE ST STE 880
MACON GA
31201-7525
US

IV. Provider business mailing address

840 PINE ST STE 880
MACON GA
31201-7525
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7092
  • Fax: 478-743-6293
Mailing address:
  • Phone: 478-743-7092
  • Fax: 478-743-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-NP239990
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberRN239990
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: