Provider Demographics
NPI:1336385475
Name:JENKINS, BRANDY GADDY (CNM)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:GADDY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1342
Mailing Address - Country:US
Mailing Address - Phone:678-633-6051
Mailing Address - Fax:
Practice Address - Street 1:3116 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1342
Practice Address - Country:US
Practice Address - Phone:678-633-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166060367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA850673599BMedicaid