Provider Demographics
NPI:1578878658
Name:JOHNSON, BRANDILYN (NP-C)
Entity Type:Individual
Prefix:
First Name:BRANDILYN
Middle Name:
Last Name:JOHNSON
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 1:6600 WHITTLESEY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7334
Mailing Address - Country:US
Mailing Address - Phone:706-323-3491
Mailing Address - Fax:706-660-9191
Practice Address - Street 1:6600 WHITTLESEY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7334
Practice Address - Country:US
Practice Address - Phone:706-323-3491
Practice Address - Fax:706-660-9191
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162979NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136036CMedicaid
GA202I501202Medicare PIN