Provider Demographics
NPI:1184829582
Name:DALTON, BRENDA DENISE (RN-C,)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DENISE
Last Name:DALTON
Suffix:
Gender:F
Credentials:RN-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 STONECREEK WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4507
Mailing Address - Country:US
Mailing Address - Phone:770-484-7770
Mailing Address - Fax:
Practice Address - Street 1:1105 WEST PEACHTREE STREET, N. E.
Practice Address - Street 2:STATION C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30357
Practice Address - Country:US
Practice Address - Phone:404-853-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR050628163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health