Provider Demographics
NPI:1205907565
Name:BRANTLEY, KENYATTA D (OD)
Entity type:Individual
Prefix:DR
First Name:KENYATTA
Middle Name:D
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:37 CALUMET PARKWAY BLDG G SUITE 101
Mailing Address - Street 2:ATTENTION: DR. KEN BRANTLEY
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263
Mailing Address - Country:US
Mailing Address - Phone:229-800-4712
Mailing Address - Fax:
Practice Address - Street 1:37 CALUMET PARKWAY BLDG G SUITE 101
Practice Address - Street 2:ATTENTION: DR. KEN BRANTLEY
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:229-800-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2025-01-31
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Provider Licenses
StateLicense IDTaxonomies
GAOPT003563152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management