Provider Demographics
NPI:1659449528
Name:ADDISON, BRENDA ANN (FNP)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:ANN
Last Name:ADDISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SMOKEY ALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-7613
Mailing Address - Country:US
Mailing Address - Phone:229-758-2942
Mailing Address - Fax:229-758-9473
Practice Address - Street 1:1109 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2022
Practice Address - Country:US
Practice Address - Phone:229-430-4127
Practice Address - Fax:229-430-5143
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN037868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily