Provider Demographics
NPI:1073848602
Name:BRONNER, QUANDRIAN M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:QUANDRIAN
Middle Name:M
Last Name:BRONNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 LOWER FAYETTEVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1133
Mailing Address - Country:US
Mailing Address - Phone:678-631-4610
Mailing Address - Fax:678-631-4611
Practice Address - Street 1:1200 LOWER FAYETTEVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1133
Practice Address - Country:US
Practice Address - Phone:678-631-4610
Practice Address - Fax:678-631-4611
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106857363A00000X
GA5662363A00000X
GA005662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant