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General NPI Number Information
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NPI Number | 1023892791
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE BRANGWIN
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Gender | Female
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 4855 RIVER GREEN PKWY STE 610
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City | DULUTH
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State | GA
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Zip | 30096-8337
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Country | US
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Telephone | 470-499-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 SOARING LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5886
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Country | US
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Telephone | 423-260-6583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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