Provider Demographics
NPI:1225686975
Name:POYTHRESS, BRENDA JOYCE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:POYTHRESS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1132
Mailing Address - Country:US
Mailing Address - Phone:912-427-8433
Mailing Address - Fax:912-427-9851
Practice Address - Street 1:391 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1132
Practice Address - Country:US
Practice Address - Phone:912-427-8433
Practice Address - Fax:912-427-9851
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210827207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine