Provider Demographics
NPI:1710396098
Name:BRAZELL, MEREDITH (PA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BRAZELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:912-466-5000
Mailing Address - Fax:912-466-5013
Practice Address - Street 1:2060 DAN PROCTOR DR STE 2100
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3895
Practice Address - Country:US
Practice Address - Phone:912-264-1520
Practice Address - Fax:912-264-1526
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007278363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical