Provider Demographics
NPI:1619083797
Name:WILLARD, BRANDI HARTMAN (NP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:HARTMAN
Last Name:WILLARD
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 1:1158 EMPEROR LN
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-3637
Mailing Address - Country:US
Mailing Address - Phone:770-307-5913
Mailing Address - Fax:
Practice Address - Street 1:4589 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7320
Practice Address - Country:US
Practice Address - Phone:770-466-8672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 149632 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily