Provider Demographics
NPI:1295164085
Name:DIGIACOMO, BRENDA (ANP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:ANP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FERRY ROAD
Mailing Address - Street 2:SUITE 910
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-303-3750
Mailing Address - Fax:404-252-4755
Practice Address - Street 1:980 JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE 910
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-303-3750
Practice Address - Fax:404-252-4755
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138898363LA2200X
GA138898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146982CMedicaid
GA20250I5973Medicare PIN