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General NPI Number Information
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NPI Number | 1205907565
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Entity Type | Individual
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Provider Name | KENYATTA D. BRANTLEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 3339 HIGHWAY 34 E
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City | SHARPSBURG
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State | GA
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Zip | 30277-3564
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Country | US
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Telephone | 770-304-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 15933 CLAYTON RD STE 210
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City | BALLWIN
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State | MO
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Zip | 63011-2172
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Country | US
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Telephone | 636-200-4393
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT003563
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPT003563
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License Number State | GA
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