Provider Demographics
NPI:1669483582
Name:SURLES, BRENDA B (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:SURLES
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3806
Mailing Address - Country:US
Mailing Address - Phone:770-534-5255
Mailing Address - Fax:770-287-3871
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:770-534-5255
Practice Address - Fax:770-287-3871
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-06-19
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Provider Licenses
StateLicense IDTaxonomies
GA052838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA964775487AMedicaid
GA964775487CMedicaid