Provider Demographics
NPI:1528583853
Name:HANSFORD, BRENDA JOYCE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:HANSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 BEST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5600
Mailing Address - Country:US
Mailing Address - Phone:804-510-0811
Mailing Address - Fax:804-716-8208
Practice Address - Street 1:4751 BEST RD STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5600
Practice Address - Country:US
Practice Address - Phone:804-510-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver