Healthcare Provider Details

I. General information

NPI: 1790358877
Provider Name (Legal Business Name): BREANNA GRIFFIN AGACNP, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA SLAUGHTER AGACNP, MSN, RN

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S BROAD ST
THOMASVILLE GA
31792-6114
US

IV. Provider business mailing address

919 S BROAD ST
THOMASVILLE GA
31792-6114
US

V. Phone/Fax

Practice location:
  • Phone: 229-584-5400
  • Fax: 229-551-8645
Mailing address:
  • Phone: 229-584-5400
  • Fax: 229-551-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN245318
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN245318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: