Healthcare Provider Details

I. General information

NPI: 1649312976
Provider Name (Legal Business Name): MARSHA L BRANTLEY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MOHAWK ST SUITE A
SAVANNAH GA
31419-1780
US

IV. Provider business mailing address

900 MOHAWK ST SUITE A
SAVANNAH GA
31419-1780
US

V. Phone/Fax

Practice location:
  • Phone: 912-920-2090
  • Fax: 912-920-4114
Mailing address:
  • Phone: 912-920-2090
  • Fax: 912-920-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN104379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: