Provider Demographics
NPI:1033510011
Name:LUNSFORD, BRANDILYNN GROLL (AA-C)
Entity Type:Individual
Prefix:
First Name:BRANDILYNN
Middle Name:GROLL
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:BRANDILYNN
Other - Middle Name:
Other - Last Name:GROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA-C
Mailing Address - Street 1:5671 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-5000
Mailing Address - Country:US
Mailing Address - Phone:404-257-1415
Mailing Address - Fax:404-851-1649
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:678-843-7324
Practice Address - Fax:404-843-2627
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant