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NPI Code Detail

MEDICARE: BRENIAH GRADDY

MEDICARE: BRENIAH GRADDY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-26-511587GA

General Provider Information

NPI Number : 1144171786
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENIAH GRADDY
Provider Business Mailing Address
First Line : 1202 TECH BLVD STE 104
Second Line :
City : TAMPA
State : FL
Zip : 33619-7863
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6100 VETERANS PKWY STE 11
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-3514
Country : US
Telephone Number : 813-438-6796
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ BRENIAH GRADDY ” Practice Location

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