Healthcare Provider Details

I. General information

NPI: 1306709639
Provider Name (Legal Business Name): HATTIE HODGES BRANNEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 GIN HOUSE RD
SYLVANIA GA
30467-3802
US

IV. Provider business mailing address

357 GIN HOUSE RD
SYLVANIA GA
30467-3802
US

V. Phone/Fax

Practice location:
  • Phone: 912-212-6022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP263884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: