Provider Demographics
NPI:1356568398
Name:OGLESBY, BRENDA S (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:S
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:207 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1812
Mailing Address - Country:US
Mailing Address - Phone:478-472-8227
Mailing Address - Fax:478-472-2500
Practice Address - Street 1:110 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068
Practice Address - Country:US
Practice Address - Phone:478-472-8121
Practice Address - Fax:478-472-2500
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN039972 NP363LF0000X
GA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily