Provider Demographics
NPI:1245473438
Name:BRAZZELL, GEORGIA MAE
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:MAE
Last Name:BRAZZELL
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 1:713 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3310
Mailing Address - Country:US
Mailing Address - Phone:386-631-0602
Mailing Address - Fax:386-624-7206
Practice Address - Street 1:713 10TH ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3310
Practice Address - Country:US
Practice Address - Phone:386-631-0602
Practice Address - Fax:386-624-7206
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath