Provider Demographics
NPI:1770844912
Name:STANLEY, BRIGETTE LEIGH
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:LEIGH
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 SPRING WOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1700
Mailing Address - Country:US
Mailing Address - Phone:678-677-4468
Mailing Address - Fax:
Practice Address - Street 1:4745 SPRING WOOD TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1700
Practice Address - Country:US
Practice Address - Phone:678-677-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator