Provider Demographics
NPI:1053838979
Name:RESPERT, BRANDY NIKIA (TPR)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NIKIA
Last Name:RESPERT
Suffix:
Gender:F
Credentials:TPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 CLUBSIDE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4722
Mailing Address - Country:US
Mailing Address - Phone:678-368-9575
Mailing Address - Fax:
Practice Address - Street 1:4705 ASHFORD DUNWOODY RD STE 18
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5566
Practice Address - Country:US
Practice Address - Phone:678-368-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier