Provider Demographics
NPI:1336180892
Name:BRANNON, WINDY MICHELLE (PT,MS)
Entity Type:Individual
Prefix:
First Name:WINDY
Middle Name:MICHELLE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 COBB PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4084
Mailing Address - Country:US
Mailing Address - Phone:770-975-1299
Mailing Address - Fax:770-975-1361
Practice Address - Street 1:1985 HOWELL MILL RD NW
Practice Address - Street 2:STE. B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2566
Practice Address - Country:US
Practice Address - Phone:404-355-1322
Practice Address - Fax:404-355-5404
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT006876OtherLICENSE #
PT006876OtherLICENSE #
GAQ43335Medicare UPIN