Provider Demographics
NPI:1326419201
Name:GRIFFIN, BRENDA KAY (PMHNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HOSPITAL DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:478-474-4343
Mailing Address - Fax:844-213-0754
Practice Address - Street 1:340 HOSPITAL DR
Practice Address - Street 2:SUITE 370
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-474-4343
Practice Address - Fax:844-213-0754
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117393363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health