Provider Demographics
NPI:1689851925
Name:BRUMBELOE, JOY (CNM)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BRUMBELOE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 HIGHWAY 54 W
Mailing Address - Street 2:STE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4514
Mailing Address - Country:US
Mailing Address - Phone:770-460-4644
Mailing Address - Fax:
Practice Address - Street 1:1260 HIGHWAY 54 W
Practice Address - Street 2:STE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4514
Practice Address - Country:US
Practice Address - Phone:770-460-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085330367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife